JP5088771B2 - Methods and instruments for rehabilitation and training - Google Patents

Description

Related applications

  This application is filed with US Provisional Patent Application No. 60 / 542,022 filed on February 5, 2004, US Provisional Patent Application No. 60 / 566,078 filed on April 29, 2004, April 29, 2004. U.S. Provisional Patent Application No. 60 / 566,079, U.S. Provisional Patent Application No. 60 / 604,615 filed on Aug. 25, 2004, U.S. Provisional Patent Application No. 60/60 filed on Dec. 7, 2004. No. 633,428, U.S. Provisional Patent Application No. 60 / 633,429, filed Dec. 7, 2004, and U.S. Provisional Patent Application No. 119, filed Dec. 7, 2004, U.S. Provisional Patent Application No. 60 / 633,442. Claims a profit under Article (e). The disclosures of these applications are incorporated herein by reference.

  This application also relates to the following title PCT application filed by the same applicant on the same day as this application. “Gait Rehabilitation Methods and Apparatuses”, “Music Rehabilitation”, “Rehabilitation with Music”, “Neuromuscular Stimulation”, “Fine Motor Control Rehabilitation”, “Fine Motor Control Rehabilitation”, “ “Method and Apparatus for Rehabilitation Training and Training” “Method and Apparatus for Rehabilitation Exercise and Training”, “Method and Apparatus for Rehabilitation and Training” “Method and Apparatus for Rehabilitation and Training”, “For Rehabilitation and Training” Methods and instruments ". Also, they have agent case numbers 414/04319, 414/04396, 414/04400, 414/04401, 414/04388, 414/04213, and 414/04405, respectively. The disclosures of all these applications are incorporated herein by reference.

  The present invention relates to physical manipulation such as physical rehabilitation and / or training.

  After an accident or stroke, a long-term rehabilitation process is often required to restore some or all of the physical functions damaged thereby. Such rehabilitation consists of one or both of the following two elements. One is physical rehabilitation, which fully restores (as far as possible) the function of damaged, unused muscles, nerves, or joints. The other is cognitive rehabilitation, which restores cognitive ability to control the body. Due to damage to the body or brain, the patient may require training for altered functions (eg, when one leg is shortened) or new functions (eg, when using a prosthetic limb).

  Physiotherapy is currently provided primarily by the individual response of a physiotherapist who observes and directs patients undergoing certain training. As a result, the cost of rehabilitation is high and the compliance after the patient is discharged from the treatment facility is relatively low.

  Several home physiotherapy devices are known, for example, “Backlife”, a product that provides CPM (Continuous Passive Motion) of the spine.

  US Pat. No. 5,836,304 (the disclosure of which is incorporated herein by reference) describes cognitive rehabilitation by a remote therapist.

  US Pat. No. 5,466,213 (the disclosure of which is incorporated herein by reference) describes a rehabilitation system using a robotic arm.

  “Rehabilitation Research and Development,” Vol. 37, No. 6, November / December 2000 (Journal of Rehabilitation Research and Development, Vol. 37 No. 6, November / December 2000) Development of robots for rehabilitation therapy: “Development of robots for rehabilitation therapy” (Charles G. Burgar, MD; Peter S. Lum, PhD; Peggy C. Shor, OTR; HF Machiel Van der Loos, PhD, The Palo Alto VA / Stanford experience "(the disclosure of which is incorporated herein by reference) describes the use of rehabilitation robots.

  A broad aspect of some embodiments of the present invention relates to rehabilitation methods and instruments adapted to a variety of situations, including temporal, mental, cognitive, motor and other situations.

  An aspect of some embodiments of the invention applies one or more boosting, assisting, cueing, responding, and / or resisting forces to the device while the patient exercises (or intends to exercise). Relates to a rehabilitation instrument that guides the patient to move in the correct spatial trajectory. In an exemplary embodiment of the invention, the force is applied by an actuator (such as a joint robot arm or ball joint lever). In some embodiments, the applied force behaves as a force field (optionally a continuous force field) that impedes and / or induces patient motion. Instead of or in addition to a spatial trajectory, an orientation trajectory and / or velocity trajectory is derived, supported and / or measured.

  In an exemplary embodiment of the invention, the device supports virtually any three-dimensional trajectory within the volume portion for a given spatial volume and force intensity range. In an exemplary embodiment of the invention, an apparatus is provided for supporting a range of motion of a healthy arm or leg in one, two or three dimensions. In some cases, some spatial volume (eg, 30% or 50% of such volume) is sufficient.

  Optionally, the device can be programmed with various trajectories (paths and / or velocities) and / or forces. Optionally, the force at a point on the trajectory depends on the trajectory that the patient actually moved (possibly the same trajectory (at a point before that trajectory)) and / or a rehabilitation plan and / or It can change as the patient progresses. Optionally, the device learns the patient's movement, makes corrections (eg, smoothes the trajectory and / or speed) and reproduces it. Alternatively or additionally, the device learns the movements entered by the physiotherapist, makes optional corrections (eg, limb size corrections), and reproduces it for the patient be able to.

  In exemplary embodiments of the invention, trajectories and / or forces are defined for one or more points on the body (ie, on the same and / or different limbs or body parts). Optionally, the points are controlled (and / or measured) with 3, 4, 5 or 6 degrees of freedom.

  In an exemplary embodiment of the invention, programming includes electronic controller programming. In an exemplary embodiment of the invention, programming includes mechanical programming.

  An aspect of some embodiments of the invention relates to a home rehabilitation device. In an exemplary embodiment of the invention, the device is portable in the home. For example, it is not permanently fixed to any surface and / or has wheels. In an exemplary embodiment of the invention, the device can be normally folded. In an exemplary embodiment of the invention, the device is sufficiently lightweight to avoid exceeding the floor load capacity of the residence. For example, the weight of the device can be less than 100 kg, less than 50 kg, or less than 25 kg. Optionally, the device can be folded to a size that can be accommodated in a standard sedan-type passenger car trunk (eg, less than a maximum dimension of 120 cm). Optionally, the device can be broken down into lightweight parts that can be fully carried by a healthy person.

  In an exemplary embodiment of the invention, the device ensures correct patient positioning. Optionally, the patient is instructed to be in the correct position. In an alternative embodiment of the invention, the device will readjust its placement taking into account the patient's position.

  In an exemplary embodiment of the invention, the device is for a plurality of different treatments (such as different body sizes, different ages, different joints, and / or different appendages, etc.). , (By programming, attachments, and / or settings, etc.).

  In an exemplary embodiment of the invention, a rehabilitation device is provided that can be carried for a variety of activities, such as cooking, barbecue, table dining, for example indoors and / or outdoors.

  Aspects of some embodiments of the invention relate to rehabilitation of daily activities such as meals, tea pouring, nailing, cooking and the like. In an exemplary embodiment of the invention, a kit is provided that includes a position sensor and / or other sensors for attaching to daily goods, tracking its use, and providing rehabilitation feedback and guidance. Optionally, such feedback and guidance is provided mechanically by a rehabilitation robot. In an exemplary embodiment of the invention, the daily activity training table has one or more adjustable work spaces on which to perform daily activities. For example, one side mimics a table and the other side mimics a saucer (eg, for tea-tearing training).

  An aspect of some embodiments of the invention relates to long-term rehabilitation and / or training. In an exemplary embodiment of the invention, the rehabilitation device is used over a long period of months or years. Optionally, the same device is used for both rehabilitation and training of the correct movement of the patient. In an exemplary embodiment of the invention, the rehabilitation device is used for preventive training. This preventive training, for example, prevents a patient with ongoing arthritis from starting to cover the affected joint. Optionally, the device is used to achieve a specific rehabilitation purpose, such as rehabilitation of a specific limb. Optionally, the device is used for non-medical training, for example as a general gym machine.

  Aspects of some embodiments of the present invention include motivation, slump, perseverance, ability to perform hard training, ability to communicate and / or collaborate and / or interact with others, etc. It relates to the support and / or measurement of various mental states of the patient. In many cases, these states partially overlap. For example, slump is often described as lack of motivation. In an exemplary embodiment of the invention, motivation is assessed by comparing performance in diagnostic, gaming and / or therapeutic situations. Such comparisons optionally include an analysis of whether they performed the same performance in different motivation states and / or how often they were tense to the limit. In an exemplary embodiment of the invention, the motivation status is utilized for assessing progress, proposing psychotherapy, adjusting the difficulty of training, and / or inspiring motivation provided automatically.

  An aspect of some embodiments of the invention relates to supporting and overcoming cognitive problems during a physical rehabilitation. In an exemplary embodiment of the invention, the cognitive and / or perceptual restrictions may be in multiple ways, in a less disturbing manner (eg, selected from various possibilities) and / or restricted. It is overcome by providing one or more of instructions, feedback, and guidance with a degree of enhancement (such as large letters for low vision) that is adapted to. In an exemplary embodiment of the invention, the degree of enhancement is changed over time as part of limited function rehabilitation.

  An aspect of some embodiments of the invention relates to multi-modal rehabilitation. In an exemplary embodiment of the invention, multiple body systems (eg, motion, vision, hearing, vision-motion), skills, and / or sensations are the same lineage (eg, motor control, motion-specific sensation, visual cognition, and Rehabilitation is performed using sound generation. In an exemplary embodiment of the invention, such coordinated movements between trains are trained. For example, rehabilitation of eye-hand coordination is performed. In another example, rehabilitation of hand-foot coordination is performed. In an exemplary embodiment of the invention, the path of coordinated movement that is impaired is subject to rehabilitation.

  An aspect of some embodiments of the invention relates to feedback for rehabilitation. In an exemplary embodiment of the invention, this feedback includes feedback about daily activities. Alternatively or additionally, this feedback includes feedback from a remote therapist or automatic feedback made during the activity. Alternatively or additionally, this feedback includes to the quality of exercise performed by the patient.

  An aspect of some embodiments of the invention relates to rehabilitation therapy. In an exemplary embodiment of the invention, in particular daily activity training is performed with the aid of a rehabilitation device. Alternatively or additionally, training is provided to prevent worsening of the condition, for example, preventing worsening of Parkinson's disease due to non-use of upper limb motor functions. Alternatively or additionally, training is provided that provides long-term improvements, such as improving cerebral palsy. Alternatively or additionally, treatments are performed to prevent illness, such as training the patient so that the joint is not moved due to pain.

  An aspect of some embodiments of the invention relates to the use of a rehabilitation device for both rehabilitation and examination / diagnosis and / or observation. In an exemplary embodiment of the invention, the device is used to assess patient performance and rehabilitate the patient. Alternatively or additionally, the device is used to measure a patient and adjust subsequent habilitation according to the measurement results. Examples of measurements include dimensions, strength, range of motion and quality of movement, mental status, cognitive and / or perceptual ability.

  An aspect of some embodiments of the invention relates to motion characteristics. In an exemplary embodiment of the invention, motion characteristics are defined. Optionally, feedback is automatically provided to the patient regarding the patient's motion characteristics when the patient is rehabilitating. Alternatively or additionally, part of rehabilitation and / or training teaches the patient various exercise characteristics.

  An aspect of some embodiments of the invention relates to motion accuracy. In an exemplary embodiment of the invention, the rehabilitation instrument is programmed with accurate movement. In an exemplary embodiment of the invention, the correct motion is programmed into the device by performing the correct motion and storing the motion in a memory associated with the device. Optionally, exercise is programmed when in teaching-only mode or when the device is offline. Alternatively, the device learns during patient use.

  Optionally, the device uses templates and rules (eg 2/3 power rules for motion control) to tell the patient what the correct motion is. In an exemplary embodiment of the invention, exercise accuracy is evaluated as a rehabilitation parameter to provide feedback about it.

  An aspect of some embodiments of the invention relates to a rehabilitation instrument for daily activities. The rehabilitation instrument herein is configured to train and / or test a patient for daily activities. In an exemplary embodiment of the invention, the rehabilitation instrument can be used in close proximity to the actual environment, such as a table or counter.

  An aspect of some embodiments of the invention relates to positioning a rehabilitation instrument that includes a motion mechanism. In an exemplary embodiment of the invention, the motion mechanism has a finite range of motion and / or accuracy. Optionally, the rehabilitation instrument is positioned to make best use of this range of motion, such as by adapting to a specific exercise. In an exemplary embodiment of the invention, the rehabilitation instrument comprises a positioning element such as a rail and / or one or more joints that can be used to secure the motion mechanism in place or orientation. Optionally, the positioning element is motorized, for example allowing automatic or non-manual movement of the movement mechanism.

  An aspect of some embodiments of the invention relates to a rehabilitation method for using a healthy body part for rehabilitation of a pathological body part. In an exemplary embodiment of the invention, the rehabilitation instrument allows the simultaneous or parallel movement of two limbs (one is impaired and the other is healthy) and provides accurate movement of the healthy limb. Used as a basis for force field definition for a limb. Alternatively or additionally, a continuous exercise with a healthy limb followed by a disabled limb is provided. Optionally, healthy motion is corrected (eg, force, speed, or range of motion is reduced). Optionally, the movement is a mirror movement or a synchronous movement (eg, arm and leg movement in swimming). In an exemplary embodiment of the invention, a device capable of holding two limbs is used. In some embodiments, two limb movements are coupled. In other embodiments, movement of both limbs is partially or completely decoupled, at least in real time.

  An aspect of some embodiments of the invention relates to a multipoint rehabilitation device. The rehabilitation device here is attached to the human body at a plurality of points that can move relative to each other, and the movement becomes a part of the rehabilitation.

  In an exemplary embodiment of the invention, the rehabilitation instrument is attached to two limbs (eg, one arm and one leg, or both arms).

  In an exemplary embodiment of the invention, the rehabilitation instrument individually allows movement in three dimensional space of two bones connected by one joint.

  In an exemplary embodiment of the invention, the device mechanically limits the movement of one or more of that point. Optionally, one or more of the points are tracked (in one or more dimensions) but are not mechanically limited in part or in any direction.

  In an exemplary embodiment of the invention, the rehabilitation device supports complex movements where different parts of the body are required to perform certain movements (eg, shoulder movements and wrist movements).

  An aspect of some embodiments of the invention relates to the mechanical structure of the rehabilitation device. In an exemplary embodiment of the invention, the device comprises an arm attached to a joint, on which the arm is mounted with a body attachment point for attachment to or gripping by the patient. The joint operates as a spherical joint, and an arm along a substantially arbitrary path on the sphere within a certain angular range (eg, ± 90 ° relative to the center of the joint in both directions φ and θ in polar coordinates). Allows for movement. Optionally, the center of rotation of such motion is the same center of rotation for substantially all paths. In exemplary embodiments of the invention, joints and / or arms are generally not good at their range of motion. Optionally, the resistance to joint motion (the device adds resistance) is substantially uniform and substantially independent of spherical motion.

  In an exemplary embodiment of the invention, the spherical joint comprises a ball-in-socket joint with an arm attached to the ball or socket. The other ball or socket is optionally attached to a base that is placed on the floor or attached to a wall or ceiling.

  In an exemplary embodiment of the invention, a balance is provided. In one example, the device comprises a weight attached to the ball opposite the arm and balancing the movement of the arm. Optionally, the movement of the arm is substantially balanced throughout its range of motion. In an exemplary embodiment of the invention, balancing includes consideration of residual torque suppression. Alternatively or additionally, balancing includes taking into account a modification of the current internal moment or an expected internal moment during use. Optionally, the device is configured according to this embodiment to include a residual force that stabilizes or destabilizes the device.

  Optionally, one or more guide plates are provided. In an exemplary embodiment of the invention, a pin (optionally part of a weight) attached to the ball can move within a slot (eg, rectangular or other shape) formed in the guide plate. Be strong. Optionally, the slot is elastic.

  Optionally, one or more motors are provided to rotate the ball and / or apply a force in a predetermined direction.

  Optionally, one or more directional brakes are provided to selectively stop the movement of the ball in the desired direction.

  Optionally, one or more unidirectional brakes are provided to selectively stop movement of the ball in any direction.

  In an alternative embodiment of the present invention, two or more joints (eg, universal joints) sharing the center of rotation are provided instead of the ball joint.

  In an exemplary embodiment of the invention, the arm is extendable along its axis. Optionally, the motor is provided for applying a force that selectively moves or resists an axially extending movement. Optionally, one or more brakes are provided to selectively resist the extension movement along the axis.

  In an exemplary embodiment of the invention, the extensions are balanced so that no spontaneous movement occurs. Alternatively or additionally, the extension can be extended to various degrees without affecting the balance of the arms.

  Optionally, the rehabilitation device can be placed in various orientations. Optionally, the device has a joint between its base and the joint.

  An aspect of some embodiments of the invention relates to a ball joint with a selectable lock. In an exemplary embodiment of the invention, a chuck is provided to selectively lock the rotation of the ball joint. Optionally, a plurality of directional brakes are provided. Optionally, one or more sensors indicate the direction in which the force is applied, and the controller selects which directional and / or unidirectional brake to release depending on the direction of the force.

  An aspect of some embodiments of the invention relates to an extension element that is optionally used as part of a rehabilitation instrument. In an exemplary embodiment of the invention, at least three portions (two end portions and a central portion) are provided, and a stretching or contracting force is applied to the central portion. The center is attached to the two ends using a rack and pinion (one rack at each end and two pinions at both ends of the center). The two pinions are interconnected by a belt so as to interlock.

  An aspect of some embodiments of the invention relates to a force feedback control mechanism that includes a spring. The elasticity can be changed by changing the effective length of the spring. In an exemplary embodiment of the invention, the spring is a spiral spring and is resilient in a direction perpendicular to the plane of the spring.

  An aspect of some embodiments of the invention relates to a force control mechanism for an element that can be moved by a person. In an exemplary embodiment of the invention, a spring is provided to counteract the force applied by a person. Optionally, the degree of force is adjustable. Optionally, the adjustment is possible by preloading a spring (or other resilient element). Optionally, the elements that a person can move are also moved by a motor, and the elasticity is optionally provided for the movement of the person. Optionally, a cushioning element such as a viscous cushioning material is provided.

  In an exemplary embodiment of the invention, the elastic element can be set to (optionally and immediately) provide the desired degree of resistance to movement. Optionally, the elastic means can be readjusted to follow the actual movement of the element.

  In an exemplary embodiment of the invention, the motor uses the first joint to move the handle and the second joint is used for elasticity.

  In an exemplary embodiment of the invention, elasticity is provided to multiple axes simultaneously by a single elastic element, with substantially no coupling between the axes.

  In an exemplary embodiment of the invention, the spherically rotating motion of the element compresses the elastic element in the axial direction to provide elasticity.

  In an exemplary embodiment of the invention, power is supplied to an element with a non-reversible gear mechanism. When reversal is detected, the movement is mechanically transferred to the elastic element, which provides elasticity.

  In an exemplary embodiment of the invention, a mechanical diode design is provided in which motion is transmitted to the lever using a gear, but the lever cannot move the gear. In an exemplary embodiment of the invention, the mechanical diode comprises a gear or a lever that engages a worm gear with a sufficiently low lead angle (ie, does not reverse), and the gear and / or worm gear when the motor rotates the worm gear. Move the lever engaged with. Due to the low lead angle, when the gear rotates, the worm gear moves axially without rotating. Optionally, the worm gear is mounted on a spring or other elastic element that provides some elasticity to the movement of the gear. Optionally, the spring is given a desired amount of prestress. Optionally, the worm gear rotates following the movement of the lever to maintain the desired tension and / or balance of elastic elements.

  An aspect of some embodiments of the invention uses at least one wire and optionally one or more robotic elements such that at least one point of three-dimensional movement of the human body is forced on the manipulator. The present invention relates to a manual manipulator that moves the human body or controls the movement of the human body. In an exemplary embodiment of the invention, the manipulator is adapted for use as a rehabilitation device. Optionally, one or more motors are provided to move the at least one point. Optionally, one or more elastic elements are provided to allow some play due to the elasticity provided by one or more wires. Optionally, three wires are provided to force 3D motion.

  An aspect of some embodiments of the invention relates to patient positioning in a rehabilitation system. In an exemplary embodiment of the invention, the system uses an imaging system to determine patient position. In an exemplary embodiment of the invention, alternatively or additionally, the position of a chair or other patient support relative to the system is determined. Optionally, a spring loaded wire system is used for relative position measurements. Optionally, a pressure sensitive mat is used.

  In an exemplary embodiment of the invention, the patient is instructed to perform one or more movements, and the relative position is determined from the trajectory of the movements. Optionally, the position is determined on the second dimension rather than on the third dimension. Alternatively, three-dimensional position and / or orientation information is determined.

  In an exemplary embodiment of the invention, the motion part of the system itself or the optical pointer part of the system marks and / or indicates the correct positioning.

  In an exemplary embodiment of the invention, once the relative position is determined, one or more exercises are modified to take into account the relative position.

  An aspect of some embodiments of the invention relates to the safety of rehabilitation instruments. In an exemplary embodiment of the invention, the rehabilitation instrument selectively breaks when shear, tension, and / or torque applied to a replaceable element (such as a pin) increases beyond a threshold 1. Includes one or more mechanical fuses. As an alternative to mechanical pins, it is also possible to use adjustable magnetic pins, in which the two parts making up the pins are attracted to each other by magnetic force. The attraction level is optionally set by moving a magnet inside one part of the pin. Torque is optionally detected by providing a serrated connection between the pin components that couples relative rotation and separation between the pin components. Optionally, a wire is provided in the pin so that the device can electrically detect wire breakage.

  In an exemplary embodiment of the invention, a deadman switch is provided to the patient that, when the patient releases the switch, the device stops or transitions to a default or dynamically determined safe mode and / or position. The Optionally, the deadman switch is attached to a wireless element that is held, for example, by a normal limb or body part (eg, kept stepped and held by hand or mouth).

  In an exemplary embodiment of the invention, for example, a voice activated stop device is provided that allows the patient to stop the rehabilitation device with a scream.

  In an exemplary embodiment of the invention, the rehabilitation instrument analyzes the movement and / or force exerted by the patient to detect the problem. For example, any large irregular motion will stop the rehabilitation instrument.

  In an exemplary embodiment of the invention, the device comprises at least one movement element that is elastic during movement so that slack (increase resistance with increasing amount of slack) occurs. Optionally, the slack provides sufficient time to detect that the user's movement is wrong and that the applied force has reached a safety limit, while the patient is It works to allow not to move according to the movement of the element.

  Examples where embodiments of the present invention may be useful are shown below. In some exemplary embodiments of the invention, a series of treatment periods are supported, including goal-oriented treatment, short-term treatment, long-term treatment, and / or prophylactic activity. In some exemplary embodiments of the invention, treatment across multiple stages of rehabilitation is optionally supported by the same device. In some exemplary embodiments of the invention, rehabilitation of multiple body parts is performed simultaneously or separately, possibly with the same device. In some embodiments of the invention, rehabilitation of multiple modalities (eg, motor control, motor feedback, visual, auditory, and / or language skills) is performed simultaneously or using the same device. Motion complexity and hierarchy ranges, simple motion of one joint, complex procedural planning of multiple limb motion, etc. are supported by some embodiments. Some embodiments of the present invention provide multiple treatment locations, for example, ICU, bed, clinic, home, and / or outdoors. In some embodiments of the present invention, multiple activity types are supported, such as specialized rehabilitation training, training training, daily activities, outdoor activities, and / or diagnostic activities. In some embodiments of the invention, multiple positions are supported, such as supine, standing and / or sitting. In some embodiments of the invention, a set of ability states such as intellectual ability, cognitive ability, and / or motor ability are supported. It should be noted that not all embodiments of the invention support all the various ranges and range limits described above.

As described above, according to an exemplary embodiment of the present invention, applying a force that interacts with movement of a patient's limb with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter. A rehabilitation method using an actuator type comprising a motion mechanism capable of preventing substantial movement at any point and in any direction within the volume portion,
Training the patient using an actuator of the actuator type that interacts with the patient's motion at a first rehabilitation location selected from a bed, a wheelchair, a clinic, and a home; and Using a second actuator of the actuator type that interacts with the patient's movement in a second rehabilitation field selected from a wheelchair, clinic, and home, causing the patient to undergo a second training. Consists of
A rehabilitation method is provided in which the first training and the second training utilize the same motion mechanism design for the operation of the actuator.

  Optionally, the first and second exercises are performed using the same rehabilitation instrument.

  In an exemplary embodiment of the invention, the motion mechanism is electric. Optionally, the movement and the force are controlled by a controller. Alternatively or additionally, the movement mechanism can apply a force of at least 10 kg to the tip of the actuator. Alternatively or additionally, the motion mechanism can apply various magnitudes of force in various directions of motion of the actuator.

  In an exemplary embodiment of the invention, the movement mechanism is adapted to selectively apply a resistance force to the movement of the actuator.

  In an exemplary embodiment of the invention, the actuator interacts with the motion in a plurality of modes including at least inducing the motion, inducing the motion, and recording the motion. Is fit to do. Optionally, the first and second exercises use different motion interaction modes.

  In an exemplary embodiment of the invention, at least one of the first and second exercises is performed in water.

  In an exemplary embodiment of the invention, the first and second exercises are performed on the same limb.

  In an exemplary embodiment of the invention, the first and second exercises are different exercises.

  In an exemplary embodiment of the invention, the method includes constantly monitoring the patient's progress including the first and second exercises in the same controller coupled to the second actuator. .

  Optionally, the actuator is not flexible.

Also, according to an exemplary embodiment of the present invention, a force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and A rehabilitation method using an actuator having a movement mechanism capable of preventing substantial movement in an arbitrary point and in an arbitrary direction in the volume part,
Training the patient's first organ using the actuator, and training the patient's second organ using the actuator;
A rehabilitation method is also provided.

  In an exemplary embodiment of the invention, the method includes replacing the attachment of the rehabilitation device to the patient between the exercises.

  In an exemplary embodiment of the invention, the actuator comprises a controller that controls the interaction. Optionally, the controller is programmed with a plurality of different exercises for different limbs.

  In an exemplary embodiment of the invention, the method includes adjusting at least one of the relative spatial position and orientation of the actuator relative to the patient between the exercises.

According to an exemplary embodiment of the present invention, a rehabilitation kit comprising:
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any An actuator having a movement mechanism capable of preventing substantial movement in a direction;
A tip on the actuator;
A plurality of modularly replaceable attachments (at least two of which fit different organs) attached to the tip;
A rehabilitation kit consisting of

  Optionally, at least one of the attachments is powered via the actuator. Alternatively or additionally, at least one of the attachments is rotatable about three rotation axes.

According to an exemplary embodiment of the present invention, a rehabilitation device comprising:
An electric actuator configured to support human movement by at least one of resisting movement, inducing movement, or causing movement;
A control device configured to control the actuator,
The control device is programmed to provide rehabilitation training in response to a plurality of switchable patient modes (one or more of motivation, cognitive ability, and motor ability being high or low) Is also provided.

  Optionally, the controller is configured to provide an indication that at least one of an information presentation mode and a complexity level is selectable.

  Alternatively or additionally, the controller is configured to provide assistance to the motor function of the patient with one assistance level selectable from at least three levels.

  Alternatively or additionally, the controller is configured to provide inspiration feedback to the patient with one inspiration level selectable from at least three levels.

Also, according to an exemplary embodiment of the present invention, a force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and A rehabilitation method using an actuator having a movement mechanism capable of preventing substantial movement in an arbitrary point and in an arbitrary direction in the volume part,
Connecting the actuator to a person in a home environment, and the person performing daily activities under the interaction of the actuator to enhance rehabilitation.
A rehabilitation method is also provided.

  Optionally, the daily activity is an outdoor activity.

  Alternatively or additionally, the actuators interact using a recorded rehabilitation plan.

  Alternatively or additionally, the actuator reports the progress of rehabilitation to a remote location.

  Alternatively or additionally, the actuator prevents dangerous movement by the patient.

  Alternatively or additionally, the method performs the first practice of daily life at a rehabilitation clinic.

Also, according to an exemplary embodiment of the present invention,
Performing rehabilitation of the first patient on the first rehabilitation device;
At least one of performing rehabilitation of the second patient on the second rehabilitation device, and information on rehabilitation between the two devices (score, recent progress, spatial position of the patient's part, and the contents of the game) Including)
A rehabilitation method is also provided.

  Optionally, using the device for input and output, the patients play a game together. Optionally, the patients play against each other. Alternatively or additionally, the first rehabilitation device is different from what the second device provides to the second patient to compensate for the difference in performance between the two patients. To the first patient.

  In an exemplary embodiment of the invention, the information is transmitted in real time.

  In an exemplary embodiment of the invention, the information is transmitted using a wireless connection.

  In an exemplary embodiment of the invention, the method includes observation of the first and second patients by a remote therapist.

  In an exemplary embodiment of the invention, the method includes a connection by the patient to a remote treatment group.

  In an exemplary embodiment of the invention, the two devices are in the same room.

Also, according to an exemplary embodiment of the present invention,
A first rehabilitation device;
A second rehabilitation,
A rehabilitation system configuration is also provided in which the second rehabilitation device is connected to the first rehabilitation by a wireless data link so that the two rehabilitation devices can operate synchronously.

Also, according to an exemplary embodiment of the present invention,
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any Providing a first actuator comprising a movement mechanism capable of preventing substantial movement in a direction;
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any Providing a second actuator comprising a movement mechanism capable of preventing substantial movement in a direction;
Subjecting the first and second actuators to a patient and a non-therapist, respectively, and rehabilitating the first patient using the first actuator and the non-therapist;
A collaborative rehabilitation method is also provided.

Optionally, the non-therapist is a relative.

  In an exemplary embodiment of the invention, the method includes guiding the non-therapist and the patient under the direction of a controller.

  In an exemplary embodiment of the invention, the non-therapist is less than 18 years old.

  In an exemplary embodiment of the invention, the non-therapist is less than 10 years old.

  In an exemplary embodiment of the invention, the preparation is made at the non-therapist's home.

  In an exemplary embodiment of the invention, the non-therapist has less than 50 hours of physical therapy experience.

  In an exemplary embodiment of the invention, the non-therapist has less than 10 hours of physical therapy experience.

Also, according to an exemplary embodiment of the present invention,
Frame,
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any An actuator having a movement mechanism capable of preventing substantial movement in a direction;
A joint interconnecting the frame and the actuator, allowing a plurality of different relative arrangements of motion mechanisms provided on the frame such that the volume portion moves relative to the frame;
A rehabilitation device is also provided.

  Optionally, the motion mechanism has different motion limits in different spatial directions. Here, the plurality of relative positions include a change in the direction of the mechanism.

  In an exemplary embodiment of the invention, the joint comprises a linear joint.

  In an exemplary embodiment of the invention, the joint comprises a rotary joint.

  In an exemplary embodiment of the invention, the frame is curved.

  In an exemplary embodiment of the invention, the joint is motorized.

  In an exemplary embodiment of the invention, the device comprises a controller that controls the joint according to the intervals between the exercises recorded therein.

  In an exemplary embodiment of the invention, the device comprises at least one sensor reporting the position of the joint.

Also, according to an exemplary embodiment of the present invention, a force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and A method of constructing a rehabilitation system comprising an actuator comprising a movement mechanism capable of preventing substantial movement in any point, any direction in the volume portion,
Determining a rehabilitation exercise to be performed; selecting a desired position of the motion control mechanism for the exercise; and adjusting the position of the mechanism on a frame according to the desired position;
There is also provided a method of configuring a rehabilitation system comprising:

  In an exemplary embodiment of the invention, the method includes automatically adjusting the position.

  In an exemplary embodiment of the invention, the method includes automatically reporting the predetermined location to a user.

Also, according to an exemplary embodiment of the present invention,
A joint having a degree of freedom of movement at spherical angles φ (rotation angle) and θ (elevation angle) and allowing a substantially arbitrary angular position within an angular range of at least 30 degrees in each angular direction by the degrees of freedom; ,
A substantially rigid radial extension element attached to the joint and adapted to move with a human limb (at least at one point thereof);
A controller adapted to control movement of the joit and movement of the radially extending element;
A rehabilitation device is also provided.

  In an exemplary embodiment of the invention, the radial extension elements are balanced so that they remain stationary if no force is applied and move when the person applies the force. Optionally, the balance can be varied to match the weight of the attachment that is selectively attached to the extender. Alternatively or additionally, the balance can be changed by the controller to match the change in moment at the point along the path of motion. Alternatively or additionally, the balance can be set to provide neutral buoyancy to the limb.

  In an exemplary embodiment of the invention, the joint is a ball joint.

  In an exemplary embodiment of the invention, the joint comprises two orthogonal hinges having a common center of rotation.

  In an exemplary embodiment of the invention, the control device comprises a mechanical control device.

  In an exemplary embodiment of the invention, the control device comprises an electrical control device.

  In an exemplary embodiment of the invention, the device comprises at least one brake adapted to selectively resist the freedom of movement. Optionally, the brake is continuously controlled by the controller. Alternatively or additionally, the brake is unidirectional in only one of the φ or θ directions. Alternatively or additionally, the brake is operable in both the φ and θ directions.

  In an exemplary embodiment of the invention, the device comprises at least one motor configured to move the coupling. Optionally, the motor is configured to apply a force of at least 10 kg to the point. Alternatively or additionally, the motor is continuously controlled by the controller. Alternatively or additionally, the motor cannot be reversed by the extender.

  In an exemplary embodiment of the invention, the device provides elastic flexibility when the person moves the point in a different trajectory than the trajectory controlled to move by the controller. At least one elastic element. Optionally, the control device sets the degree of suppleness.

  In an exemplary embodiment of the invention, the element is extensible.

  In an exemplary embodiment of the invention, the element has a power conduit.

  In an exemplary embodiment of the invention, the device comprises at least one position sensor reporting the angular position of the joint.

  In an exemplary embodiment of the invention, the device comprises at least one force sensor that reports the force applied to the joint.

  In an exemplary embodiment of the invention, the control device controls the movement, assists movement by the patient's limb, provides resistance to movement by the patient's limb, the patient At least one of inducing movement by the limbs of the patient, projecting and signaling to move to the limb of the patient, and moving the limb of the patient.

  In an exemplary embodiment of the invention, the controller can store a plurality of different rehabilitation exercises.

Also, according to an exemplary embodiment of the present invention,
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any An actuator having a movement mechanism capable of preventing substantial movement in a direction;
At least one weight balancing the actuators so that no force is required to support the actuators in space;
A well-balanced rehabilitation instrument is also provided.

Also, according to an exemplary embodiment of the present invention,
Using one actuator to assist the movement of the patient along the trajectory, and providing a supple resistance in the direction off the trajectory to the movement of the patient off the trajectory;
There is also provided a rehabilitation method in which the suppleness is achieved mechanically without electronic / mechanical feedback loops.

  In an exemplary embodiment of the invention, the suppleness is provided by a brake.

  In an exemplary embodiment of the invention, the suppleness is provided by at least one elastic element.

  In an exemplary embodiment of the invention, the method includes tracking the patient's movement with the suppleness.

  In an exemplary embodiment of the invention, different resistance forces are provided along the movement at different points in space.

  In an exemplary embodiment of the invention, different resistance is provided in different directions at the same point in space.

  In an exemplary embodiment of the invention, the flexibility is at least 1 cm.

Also, according to an exemplary embodiment of the present invention,
A lever configured to move with a portion of the patient's body;
A motor operably connected to the lever to prevent reversal of the motor by the lever (operating to move the lever);
A spring coupled to the lever and providing elasticity to the movement;
A rehabilitation device is also provided.

  In an exemplary embodiment of the invention, the spring provides the elasticity only when the lever moves differently than the motor causes.

  In an exemplary embodiment of the invention, a force is applied to the spring when attempting to reverse the motor.

  In an exemplary embodiment of the invention, the spring is provided with a controllable preload.

  In an exemplary embodiment of the invention, the device comprises a cushioning element parallel to the spring.

Also, according to an exemplary embodiment of the present invention,
A lever configured to move with a portion of the patient's body;
A motor operably connected to the lever to move the lever;
A slot for inducing movement of the lever;
A spring coupled to the lever and providing elasticity to the movement;
A rehabilitation device is also provided.

  In an exemplary embodiment of the invention, the spring is incorporated in the slot.

Also, according to an exemplary embodiment of the present invention,
A first set of at least one joint configured to allow movement of the radially extending lever in polar coordinates;
A second set of at least one joint configured to allow movement in the first set of polar coordinates;
A resilient element having a compression associated with the movement of the lever, and thus flexible for the movement of the second set;
A multiaxial elastic element for rehabilitation is also provided.

  In an exemplary embodiment of the invention, the elastic element has a configurable preload.

Also, according to an exemplary embodiment of the present invention,
A lever configured to move with a portion of the patient's body;
A motor operably connected to the lever to move the lever;
A spring coupled to the lever and providing elasticity to the movement;
There is also provided a rehabilitation device, wherein the spring has a settable flexibility.

  In an exemplary embodiment of the invention, the flexibility is set by a control device. Optionally, the setting is continuous.

  In an exemplary embodiment of the invention, the spring is a thin leaf spring having a configurable effective length.

Also, according to an exemplary embodiment of the present invention,
At least three telescope parts consisting of one central part and two end parts;
An actuation mechanism extending the central portion;
A first rack and pinion mechanism connecting one of the end portions and the central portion;
A second rack and pinion mechanism connecting the other one of the end portions and the central portion;
A belt operably connecting the two rack and pinion mechanisms;
An extension mechanism is also provided consisting of

Also, according to an exemplary embodiment of the present invention,
A base to stabilize the device against the ground and objects,
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any An actuator having a movement mechanism capable of preventing substantial movement in a direction;
The device comprises:
A first arrangement suitable for performing rehabilitation;
A second arrangement suitable for storage;
And the apparatus is configured to allow an amateur to manually switch between the arrangements,
A portable rehabilitation device is also provided.

  In an exemplary embodiment of the invention, the device is disassembled for the second arrangement.

  In an exemplary embodiment of the invention, the device comprises at least one quick connection.

  In an exemplary embodiment of the invention, the device is foldable.

  In an exemplary embodiment of the invention, the device can be folded flat for storage in a car trunk.

  In an exemplary embodiment of the invention, the device is less than 30 kg.

  In an exemplary embodiment of the invention, the device is equipped with wheels.

Also, according to an exemplary embodiment of the present invention,
A lever configured to move with a portion of the patient's body;
A motor coupled to the lever and configured to interact with the movement of the lever;
At least one separable element configured to interconnect the motor and the lever and disconnect at least a portion of the lever from the motor when a predetermined force is exceeded;
A rehabilitation device is also provided.

  In an exemplary embodiment of the invention, the element comprises a shear pin.

  In an exemplary embodiment of the invention, the element comprises a separable joint.

  In an exemplary embodiment of the invention, the element is connected between the lever body and an attachment attached to the lever.

Also, according to an exemplary embodiment of the present invention,
A lever configured to move with a portion of the patient's body;
A motor coupled to the lever and configured to interact with the movement of the lever;
At least one elastic element interconnecting the motor and the portion;
A controller configured to identify a safety issue and stop the motor immediately after the determination (the elastic element prevents the stop from being immediate);
A rehabilitation device is also provided.

In an exemplary embodiment of the invention, the device is capable of applying a force that interacts with the movement of the patient's limb with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter. An actuator having a motion mechanism is provided.

  In an exemplary embodiment of the invention, the controller identifies the safety issue by detecting a scream by the patient.

  In an exemplary embodiment of the invention, the control device calculates the safety by calculating at least one position of a point of the patient's body and comparing the result of the calculation with one or more tolerances. Identify the problem.

Also, according to an exemplary embodiment of the present invention,
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any An actuator having a movement mechanism capable of preventing substantial movement in a direction;
At least one actuator configured to assist in rehabilitation;
A docking port configured to lock the patient carrier;
A rehabilitation docking station is also provided.

  In an exemplary embodiment of the invention, the port is configured to engage a wheelchair.

  In an exemplary embodiment of the invention, the port is configured to engage a bed.

  In an exemplary embodiment of the invention, the station is mobile.

  In an exemplary embodiment of the invention, the station comprises at least one port for attachment of a second actuator.

Also, according to an exemplary embodiment of the present invention,
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any Providing an actuator with a motion mechanism capable of preventing substantial motion in a direction;
Coupling the actuator to a point on the human body, and applying a force vector to the point by the actuator (the force includes rotation);
A rehabilitation method comprising:

  In an exemplary embodiment of the invention, the force vector has at least two directions of rotation relative to the force vector.

  In an exemplary embodiment of the invention, the method includes applying a second force to at least a second point of the human body simultaneously with the first force.

Also, according to an exemplary embodiment of the present invention,
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any Providing a first actuator with a motion mechanism capable of preventing substantial motion in a direction;
Coupling the first actuator to a first point on the human body;
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any Providing a second actuator with a motion mechanism capable of preventing substantial motion in a direction;
There is also provided a rehabilitation method comprising coupling the second actuator to a second point on the human body and applying different forces to the two points using the two actuators.

  In an exemplary embodiment of the invention, the first actuator provides rotation.

  In an exemplary embodiment of the invention, the different points are on the same limb.

  In an exemplary embodiment of the invention, the different points are on different limbs. In an exemplary embodiment of the invention, the method includes training two limbs together. Alternatively or additionally, the method includes copying motion from one limb to the other.

Also, according to an exemplary embodiment of the present invention,
A force interacting with the movement of the patient's limb can be applied with at least three degrees of freedom of movement of the actuator in a volume portion of at least 30 cm in diameter , and any point in the volume portion, any Controlling the movement of at least one point on an organ with an actuator comprising a movement mechanism capable of preventing substantial movement in a direction;
Controlling the position of at least a second point on the organ;
Reconstructing a bending amount of at least one joint of the organ from the movement and the position by a computer;
A method of inverse kinematics is also provided.

Also, according to an exemplary embodiment of the present invention,
An actuator comprising a movement mechanism capable of applying a force that interacts with movement of a patient's limb at least in a volume portion of 30 cm in diameter ;
A patient support,
A control device configured to adjust rehabilitation training according to a relative position of at least one of the patient, the support and the actuator;
A rehabilitation device is also provided.

  In an exemplary embodiment of the invention, the device comprises a distance sensor to determine the relative position.

  In an exemplary embodiment of the invention, the apparatus comprises an image processing sensor to determine the relative position.

  In an exemplary embodiment of the invention, the control device relates to the relative arrangement of the patient and the actuator.

  In an exemplary embodiment of the invention, the controller considers relative positions to differ only in two dimensions.

  In an exemplary embodiment of the invention, the device comprises a pointer that indicates the desired patient placement.

  In an exemplary embodiment of the invention, the controller is configured to use the actuator to determine the relative placement.

  In an exemplary embodiment of the invention, the controller is configured to use the actuator to indicate a desired relative arrangement.

  In an exemplary embodiment of the invention, the controller is configured to immediately adjust the training during a training session and in response to patient movement.

Also, according to an exemplary embodiment of the present invention,
A storage device for storing the correspondence between the training and the payment code;
A controller configured to control rehabilitation training and to generate a report including code corresponding to the training from the storage device;
A rehabilitation device is also provided.

Also, according to an exemplary embodiment of the present invention,
At least one actuator configured to support movement of a body part;
At least one sensor for measuring the movement associated with the actuator;
A controller that analyzes the evaluated motion to generate an index of motion characteristics, and that modifies a rehabilitation plan in response to the motion characteristics index;
A rehabilitation device is also provided.

  In an exemplary embodiment of the invention, the controller modifies subsequent training selections according to the evaluated motion characteristics.

  In an exemplary embodiment of the invention, the controller modifies subsequent training parameter selections according to the evaluated motion characteristics.

  In an exemplary embodiment of the invention, the motion characteristic indicator used is defined as a goodness of fit to 2/3 power law.

Also, according to an exemplary embodiment of the present invention,
Having a person perform at least one training,
Assessing the mental state of the person from the result of the at least one training;
Automatically selecting at least one second exercise according to the evaluation;
A rehabilitation method comprising:

  In an exemplary embodiment of the invention, the mental stage assessment includes comparing performance between two exercises, one of which is expected to elicit higher compliance.

  In an exemplary embodiment of the invention, the assessment of the mental stage includes comparing performance in one exercise using the patient's maximum ability as a criterion for determining deviations therefrom.

  In an exemplary embodiment of the invention, the evaluation is made automatically.

Also, according to an exemplary embodiment of the present invention,
Determining the patient's ability to perform exercise tasks;
Determining the patient's ability to perform non-motor tasks, and automatically selecting patient training or training parameters in response to the determination;
A rehabilitation method comprising:

  In an exemplary embodiment of the invention, the selection includes adapting the mode of instruction or feedback to the perceptual ability.

  In an exemplary embodiment of the invention, the selection includes adapting the mode of instruction or feedback to cognitive ability.

  In an exemplary embodiment of the invention, the selection includes training (or a series of training) designed to rehabilitate both the exercise and the non-motor ability.

  In an exemplary embodiment of the invention, the training provides visual-motor coordination rehabilitation.

Also, according to an exemplary embodiment of the present invention,
Moving an electric actuator having a tip to a spatial position within a volume portion of at least 30 cm in diameter ;
Instructing the patient to apply a force against the tip, and the actuator provides a resistance corresponding to the force;
A rehabilitation method comprising: Optionally, the method includes selecting a resistance force as a function of spatial location.

  Non-limiting embodiments of the present invention are described below with reference to the drawings. The drawings are not generally drawn to scale and any dimensions are merely exemplary and not necessarily limiting. In the drawings, identical structures, components or parts that appear in one or more drawings are, where possible, given the same or similar reference numerals in all the drawings in which they appear.

[Introduction]
The methods and instruments of some embodiments of the present invention provide controlled or partially controlled or directed movement of a body part. The following sections describe this device by first describing the design of an exemplary device (joint arm) and then describing the various rehabilitation methods and then the design and use of additional rehabilitation devices. The present invention should not be regarded as limited to the particular apparatus used to describe the particular method. Rather, many of the methods can be performed by various devices, and many of the devices can be used to perform various methods.

[Joint arm design]
FIG. 1 schematically illustrates an articulated arm rehabilitation instrument 100 according to an exemplary embodiment of the present invention. In part of the description, reference is made to device 100 for convenience of description for other devices described herein. The term “system” is used instead of referring directly to the device 100 in some places, and may include multiple devices and monitors.

  The apparatus 100 includes an articulated arm 102 that protrudes upward from a table or other pedestal 104. The distal end portion 108 of the arm 102 functions as a control point that can move in various three-dimensional trajectories. Optionally, instead of securing the pedestal 104 to the floor, the weight of the pedestal is increased by an optional weighted base 106 (located at a location not shown), causing the device 100 to tilt or tip over during use. You can also avoid it. Optionally, the base 106 comprises an electronic instrument that is used to power the arms. Alternatively or additionally, the weight 106 is a temporary weight (eg, a sac filled with water). Other exemplary general layouts are shown below.

  In an exemplary embodiment of the invention, arm 102 is an articulated arm that supports movement in three-dimensional space. Alternative designs (e.g. based on one joint and an extension arm) are described below.

  In the exemplary embodiment of the invention, arm 102 comprises a plurality of portions 110 that are interconnected by a plurality of joints 112. In an exemplary embodiment of the invention, each joint is motorized, as is known, for example, in the robot arm art. Alternatively or additionally, for example, as described below, each joint can be selectively locked. Optionally, an angular position sensor is provided at each joint and / or a position sensor at the tip 108 so that the spatial position of the arm 102 and / or the tip 108 can be determined. The joint may be a joint having 1, 2, or 3 or more degrees of freedom.

  In an exemplary embodiment of the invention, arm 102 (eg, its locking and / or force application, and / or movement) is controlled by controller 114 (eg, a personal computer or a dedicated embedded computer). Is done. Optionally, display 116 and / or user input device 118 are used for user interaction. Optionally, display 116 comprises (or is limited to) an audio display (eg, providing sound and / or language instructions and / or feedback).

  For example, an external connection 120 for connection with a remote computer and / or other unit is optionally provided for use as described below in FIG.

  It should be noted that some implementations of device 100 do not include a computer at all. Some implementations do not require any power. In one example, a mechanical computer is used to control device parameters. In some embodiments of the invention, resistance to movement (optionally variable) using the brake system is provided.

[Details of arm]
As will be described in more detail below, various rehabilitation methods according to exemplary embodiments of the present invention require various types of movement and / or reactivity from the arm 102 or other devices described below. And The use of the rehabilitation device 100 in some embodiments of the present invention may impose certain limitations on, for example, smoothness of motion, reactivity, coupling between axes, balancing, and / or supported range of motion. Imposed on.

  For example, some styles of rehabilitation according to exemplary embodiments of the invention require the patient to move the tip 108 along a trajectory. The resistance is predefined along the trajectory, and in some cases, no resistance is given at all. In any case, as long as the patient's movement is correct, it is desirable that the device 100 does not adversely affect the patient's movement. In certain embodiments, the tip 108 provides no resistance to movement along a particular trajectory and strongly resists movement that does not follow a particular trajectory. Such a tip is referred to as a “neutral tip of motion induced by neutral”.

  In order to support a generalized three-dimensional trajectory in a neutral manner (eg, providing resistance at least along the trajectory of motion), the arm 102 has a predetermined practical range of motion (eg, a radius of 0.8 meters). In the following, it is optionally required that there be no singularity point in a sphere of 0.5 meters or less, for example. The term “specificity” refers to the movement of one or more joints from which to move to an adjacent point, and relatively large changes in joint position (generally time consuming, with rapid resistance and delay to the patient). Is used to define point and arm positions that require Further, providing neutral motion means that uniform (and preferably zero) resistance is provided at any point within the desired range of motion. Alternatively, even more important in some embodiments of the present invention is that any change in resistance is smooth. In some embodiments, the arm 102 may provide a counteracting force or even provide motion. Such force uniformity and controllability is required in some embodiments of the invention. In some embodiments, the tip 108 is configured to support the patient's limb such that the limb feels buoyancy.

  The amount of force that arm 102 can apply and / or resist depends on the rehabilitation therapy used. For example, some rehabilitation modes require an arm 102 that can withstand, for example, 100 KG of force applied to the tip 108 and resists inaccurate movement completely. In another example, it is sufficient if the arm resists exercise with a force up to a certain level (eg, 1 kg) at which the patient feels resistance. In some embodiments, a noticeable force (eg, 10 kg) is useful to prevent the patient from inadvertently moving the tip 108 against the force.

  In an exemplary embodiment of the invention, the range of motion of the tip 108 spans a 50 × 50 × 50 cm volume. In other embodiments, a smaller or larger volume is provided. The volume portion need not be rectangular. Optionally, the volume portion also includes rotation about the tip 108 about one, two or three axes. In some embodiments, the movable volume of the tip is one or two dimensional (ie, in-plane or along a line).

  In some embodiments of the inventive arm, the inventive arm 102 is required to respond to patient activity in a natural manner or at least in a manner that does not interfere with the patient's movement. In an exemplary embodiment of the invention, the responsiveness of the arm 102 is faster than 10 ms, more preferably faster than 5 ms.

  A common property of many mechanical systems is that manufacturing tolerances, detection tolerances, design, and / or structural non-optimities provide some uncontrollable freedom of movement. In an exemplary embodiment of the invention, the total amount of uncontrolled free movement in device 100 is less than 5 mm or less than 2 mm. In some embodiments of the invention, a spring loading mechanism is used to suppress unrestrained backlash motion.

  Robot technology to achieve such range of motion and responsiveness and force is probably well known, perhaps at high cost. In the following, further various techniques suitable for this will be described. Optionally, the controller 114 controls the arm 102 in a passive, automatic or responsive manner with respect to these objects. In an exemplary embodiment of the invention, such active control of arm 102 results in at least 80% or more of the moment of inertia of arm 102 being compensated. It should be noted that different values are required for different situations (eg, high or low responsiveness or large or small uncontrollable freedom).

  The arm 102 has a length of, for example, 1 meter, 0.8 meter, 0.5 meter, 0.3 meter, or somewhat longer, shorter, or intermediate therebetween.

[Exercise type]
In the device 100 as described, the controlled motion is a single point (ie, tip 108) motion. By providing various attachments for the tip 108, the tip 108 is connected to, for example, a bone, a joint, or another part of the body. The attachment is rigid as a handle or rest, for example using a strap or depending on patient cooperation or patient activity. For example, separate attachment devices for hands, arms, elbows, knees, ankles, and / or shoulders are provided. In addition, as will be described below, a plurality of tips 108 (optionally with each individual arm 102) are provided for attachments that attach to various points of the body on the same or different body parts.

  In providing rehabilitation, various types of exercise are supported, eg, one or more of the following listed.

  a) Passive exercise. The tip 108 is moved (by the device 100) and the patient moves with it.

  b) Resistance exercise. The patient moves the tip 108 to resist resistance. The resistance may be variable in size, uniform in all directions, or directional.

  c) Auxiliary exercise. As the patient moves the tip 108, positive feedback on the arm 102 increases the force of movement in the direction in which the patient moves.

  d) Force field exercise. The patient moves the tip 108. Resist a certain level of resistance (or no resistance) along a certain trajectory. Deviation from orbit is not allowed or resisted. FIG. 3A shows an example of such a force field. Movement along the “correct” trajectory 302 is not resisted or possibly assisted. In the volume 304 surrounding the track 302, increased resistance is shown. Even greater resistance is shown in the peripheral volume 306. In the outer volume portion 308, motion inhibition is provided. In an exemplary embodiment of the invention, a correction force vector 310 directed toward the trajectory 302 is applied when it deviates from the trajectory 302. Optionally, instead of the corrective force, the resistance changes as a function of distance from the trajectory 302, so that the movement of the tip 108 is naturally encouraged to return to the trajectory 302. FIG. 3B is a graph illustrating an exemplary relationship between departure from the path and applied force. Optionally, the force is applied in the path direction. Alternatively, the force is probably a unidirectional resistance force.

  This type of exercise can be used to assist the patient in training the desired exercise.

  e) Mirror movement. For example, for bilimb rehabilitation as described below, the movement of the tip 108 is required to faithfully mirror the trajectory of the movement of the different elements.

  f) Free movement. The patient moves the tip 108 as desired (possibly with feedback). As the patient (or therapist or caregiver) moves the tip 108, the device 100 can record the movement for later playback. The motion (or path) previously recorded in the playback mode is optionally reproduced using another mode. Optionally, the recorded path is corrected, for example, automatically or manually (eg, editing such as smoothing is performed).

  g) General force field. Regardless of any particular trajectory, a force field and / or auxiliary force field is defined. For example, a range of trajectories for the user to perform, or a simulated real or virtual state (eg, water, areas with obstacles) are allowed.

  h) Local force field. Force field applied only in small places and / or in one or two dimensions.

  i) Limited exercise. One or more points on the subject's body are supported or restrained from moving. Optionally, the angle between such a point and the moving point to the patient is measured. In one example, the elbow is secured by a professional brace that allows only shoulder movement. In some embodiments, the restriction is partial and / or provided by a movable element (eg, arm 102).

  j) Leading movement. The patient begins a movement (eg, 1 cm movement, or 100 grams of force) and the device 100 completes the movement or helps the patient complete. Completion of the movement may be for the entire trajectory or for a portion of the trajectory.

  k) Suggested exercise. The device 100 begins exercising and the patient completes it. The device 100 can assist in the remaining exercises in various ways (eg, by changing to one of the modes described herein after the exercise has begun). If the patient fails to capture motion, the device 100 will give a cue (eg, an audio cue). Different parts of one movement trajectory each have a machine start definition. Optionally, if the patient's movement is too slow, the device 100 starts exercising.

  l) Cue movement. The patient receives a cue from the system before exercise in another mode begins. The cue can be, for example, vibration of the tip 108, a stimulation pad applied to the skin, audio or visual cue. In some embodiments of the invention, the strength of the cues and / or their timing, and / or other ongoing activities (eg, visual display or game) may be used to coordinate motor coordination between different modalities (eg, hand- Used to support training of eye movement coordination. Exercise cues can be used for kinesthetic training.

  m) Education mode. The apparatus 100 is trained to exercise. In one example, the therapist performs an exercise and the exercise parameters at each point are recorded and can be used for training. Another way to make the system remember is to use the path used by the therapist. The therapist may use the controller to indicate points to be remembered, or may define a continuous mode to remember the entire trajectory. Optionally, paths and points are edited before playback. Optionally, the path is extracted prior to playback, for example by smoothing or specifying a motion point.

  Thus, in some embodiments of the present invention, the rehabilitation device 100 can provide one or more of isokinetic, isotonic, and isostatic training.

  It should be appreciated that the definition of the trajectory followed by the tip 108 can include velocity parameters (eg, path trajectory, velocity trajectory, force trajectory). For example, the user is assisted, urged or required to move the tip 108 at a certain speed. The speed is, for example, an absolute speed or a relative speed (eg, a constant speed or a speed that matches a non-uniform profile is required).

  Optionally, an angular trajectory (setting the angular orientation constraint of the tip 108) is defined. In some embodiments, the constraint is one-dimensional. In other embodiments, it is two-dimensional or three-dimensional.

  Velocity, angle, and spatial trajectory in a particular rehabilitation scenario may each belong to different types of motion as described above. For example, even if the velocity trajectory is free or assisted, the spatial trajectory may be a force field type. The trajectory and / or its parameters may also change along the trajectory as a function of time and / or as a function of previous performance. For example, for the type of movement performed firmly (or more than expected) in the first half of the trajectory, less assistance is provided in the second half of the trajectory.

  A trajectory is absolutely defined, for example, as a function of a stationary point or a different point on the device 100. In another embodiment, the trajectories are quite relative. For example, requiring the patient to move his arm in a straight line regardless of the starting point. In yet another embodiment, the trajectories are partially relative. Once the motion starts, it determines the remaining shape of the trajectory. For example, the first part of the trajectory suggests whether the patient is standing or sitting and what type of hand movement is predicted from it.

  In some embodiments, as described below, when multiple points 108 are defined, the motion type of each point may be a different type. In some embodiments, what is defined is a trajectory as a function of two or more points in space. For example, if two points are used to define elbow placement (eg, the angle between the humerus and forearm bones), trajectory constraints may be defined based on elbow motion. Such movement is relative in space (eg, a comparison of the two points) and not absolute (eg, compared to a device reference point). In another example, different points are given different limits (eg, angular limits at one point and speed limits at another point).

  In some embodiments of the present invention, a tensor or tensor field is provided in which each point in space is associated with velocity, force, and / or rotation (all of which can take scalar or vector quantities). It should be noted that.

  In some embodiments of the invention, different modes are defined for different parts of the trajectory or for different parts of the space (eg for a particular arm). Optionally, modes are triggered based on actual performance. For example, a more supportive mode is provided when the exercise speed is below a certain threshold. Similarly, a pause above the threshold suggests a more supportive mode. Accurate exercise suggests a mode with less support.

  In exemplary embodiments of the invention, approaching a patient's motion limit (eg, range of motion) or approaching a cognitive limit (eg, spatial neglect zone, or time neglect, eg, for long periods of motion). Sometimes the mode is automatically changed.

[Example of use]
FIG. 4A is a flowchart 400 of a method of using apparatus 100, according to an illustrative embodiment of the invention.

  At 402, the device 100 is powered on (for an electrical device). Optionally, device 100 is activated when arm 102 is touched or moved a certain amount. Alternatively, movement of arm 102 provides power to device 100.

  At 404, if the remote connection 120 is used, the device 100 optionally indicates instructions (eg, suggested activities, and / or expected courses, and / or results from physical therapy elsewhere). Download. Optionally, the patient causes device 100 to identify itself by user input 118, for example using a code, selecting a name from a list, or using a smart card or magnetic card. Optionally, patient rehabilitation information is stored or indexed on such a magnetic card or smart card, or on a portable flash memory device or portable hard disk.

  At 406, an activity to perform is selected. In more automated devices, the selection is made, for example, automatically or by the patient from a list of choices to be displayed. In a less automated device, the patient performs, for example, according to a chart provided by a rehabilitation center or a guidance therapist.

  At 408, the arm 102 is optionally moved to the starting position, eg, by the device 100 or by the patient (eg, by allowing the patient to do so directly or by the device 100). Note that for some trajectories, the starting position is not predetermined. Instead, the actual starting point is used to define the remaining trajectory.

  In some embodiments of the invention, the position of the patient relative to the system is shown or measured (eg, by the visual system, by mechanical attachment) and the program is modified accordingly.

  In some cases, the device 100 is adjusted in other ways. For example, a particular handle is attached to the tip 108 or the device leg is raised or lowered. In a foldable device (eg, a folding leg), the device is set up. Optionally, the setup is performed prior to operating device 100.

  At 410, an optional warm-up session is performed on the patient to ensure that the patient is ready for activity. Optionally, one or more physiological sensors, such as muscle temperature sensors (eg, skin surface), are used to confirm that the patient has warmed up sufficiently (eg, as a safety feature).

  At 412, the patient is optionally tested to confirm the current expected capacity.

  At 414, the results of the test are optionally used to modify one or more parameters of the selected activity, for example, depending on the success or failure of the patient under test, or to select a different activity. Is done. Exemplary modifications include the following. Expected speed reduction, anticipated force or resistance relief, anticipated or tolerable range of joints and iterations.

  At 416, an activity is performed (eg, 20 consecutive repetitive movements or movements by the patient with 0.5 kg of resistance along the entire trajectory). In another example, the resistance increases as a function of speed, or optionally uses one or more combinations of the above modes when the speed is higher or lower than a predetermined speed trajectory.

  At 418, various measurements that are optionally made during the activity are optionally recorded. Such recording may also be performed simultaneously with the activity.

  At 420, activity-based feedback is provided to the patient, rehabilitation professional, and / or device 100, for example. Optionally, feedback about the patient's physiological condition is also provided (eg, determining fatigue based on movement irregularities and / or based on pulse, other physiological parameters).

  At 422, it is optionally determined whether to repeat the activity once again and / or select a new activity. Such a determination is made based on, for example, the patient's progress and / or fatigue.

  In an exemplary embodiment of the invention, device 100 automatically generates a report used for CPT codes and other billing. Alternatively, a report is generated that is approved and / or modified by a human therapist. In some embodiments of the invention, the patient's course is used to evaluate future payments and / or training and / or suggested human guidance. Optionally, such future factors, patient improvement, elapsed time, and / or patient motivation using the system and improving using the system may be an economic Used to determine social support.

  In an exemplary embodiment of the invention, if no improvement in function or other measurement is seen after a predetermined time (eg, several weeks), it may be decided to stop financial support. In another example, treatment support may be extended based on certain documented improvements (eg, patient accuracy). In another example, the payer of treatment costs may require minimal system usage (eg, when the system is delivered to the patient's home). The payer can review the current usage report (possibly online) and decide whether to extend or stop usage.

  In an exemplary embodiment of the invention, the system can simply generate codes and / or reports, for example using a look-up table (each training has a corresponding code), and can be used for motivation and planning. Automatically generate reports on other factors, such as completion.

[Planning and long-term process]
FIG. 4B is a flowchart 430 of long-term use of the device 100, according to an illustrative embodiment of the invention.

  At 432, a new patient identified as needing rehabilitation is tested, perhaps utilizing the device 100. For example, such tests include tests of range of motion, tests of maximum applied force at different points in space, and / or tests of accuracy of force control and motion control. In an exemplary embodiment of the invention, device 100 calculates limb dimensions (or detected with a camera), adjusts pre-stored training (eg, their trajectories, and / or Use the limb dimensions (to adjust the starting point).

  At 434, the results of the test are analyzed to determine what is needed for the patient and to develop a rehabilitation objective. This process may be manual, automatic, or manual with assistance from the device 100, for example.

  At 436, a rehabilitation plan is created. This plan may include, for example, one or more expected progress charts, various allowed and / or required training, training parameters for various parts of the plan, setting of training difficulty increase / decrease, allowed and / or Or the order of training required, the number of iterations of each training, warm-up requirements, a list of data to be recorded, a list of information that can be changed by the patient, one or more satisfactory safety parameters, and / or alert the patient One or more alarm values and / or rehabilitation requiring patient follow-up are included. Creating a rehabilitation plan is a known task, but for example one or more long-term rehabilitation possibilities (it will be necessary to make the device available at home for several short periods of time) Planning that takes into account the provision of multiple activities used, the need for remote observation, and / or the programmability and responsiveness of the device in some embodiments of the invention is unique. The plan can be created manually, automatically, or manually with the assistance of the device 100. For example, the initial plan is automatically created and then annotated or approved by human hands.

  At 438, the plan is executed while being observed. In an exemplary embodiment of the invention, the observation is manual. As an alternative, at least part of the observation is performed automatically.

  At 440, the plan is modified in response to the observation. For example, if a delay in progress is recognized, the planning period is changed.

  In some cases, new problems arise or become apparent as rehabilitation progresses. If so, the plan is modified (440). In other cases, the test is repeated to a lesser extent than when the patient was initially evaluated (442).

  In some plans, periodic tests (eg, with device 100 at the patient's home) are incorporated into the plan. Such an evaluation test is used to determine when the rehabilitation is complete.

  At 444, the rehabilitation is almost complete, and a training plan is optionally performed, for example to ensure maintenance of the rehabilitation, or for other reasons (such as preventing deterioration or non-use of limbs / joints).

  At 446, long-term observation of the patient is performed, for example, once a week and once a month, the patient's ability is tested.

  At 448, new needs for the patient are confirmed, for example, by observation or by a regular routine examination. In some cases, a patient undergoing stroke rehabilitation is determined to require rehabilitation after some time due to the progressive arthritic condition. In an exemplary embodiment of the invention, a patient personal profile is created. For example, such a profile includes a series of items to be addressed (eg, smoothness of movement, etc.). The items can be addressed one by one over time or when a certain threshold is detected during the test (eg, the motion characteristic falls below the threshold).

  As pointed out herein, the unique properties of some embodiments of the present invention include a variety of including long-term treatment, patient monitoring from initial rehabilitation to follow-up rehabilitation (eg, maintaining competence), and diagnosis. The device 100 is used in a different situation.

  In an exemplary embodiment of the invention, a patient's ability and / or progress is scored. In an exemplary embodiment of the invention, the score is used to assist in determining future rehabilitation needs and / or types. Alternatively or additionally, the score is used to observe the effects of rehabilitation training and / or assist in training selection. Alternatively or additionally, the score is used to ensure that patient needs (eg, personal rehabilitation needs or balanced rehabilitation needs) are satisfied. In an exemplary embodiment of the invention, score scoring is used to identify the extent of progress, the extent to which additional or modified treatment is necessary due to lack of progress.

[Scoring and time evaluation]
In an exemplary embodiment of the invention, one or more of the following means are used to score patient performance and / or progress.

  a) The exercise score is a range of motion, exercise time, force, smoothness, no tremor, degree of tremor, spasticity, muscle tone, accuracy, exercise characteristics, and / or force elaboration (force control) For example, do not break an egg). These are defined for a single joint or a complex movement, for example, picking with a finger, grasping with a hand, moving an arm. In addition, some functional scores are used, such as, for example, the speed at which the patient moves a full glass and the ability to pick and place (pick up and place things in place).

  b) Cognitive scores include movement (motor skills) and sensation (eg perception, hearing), reaction speed, work success rate, completeness, error, planning ability, complexity level of instructions used (level 1 is, for example, screen And level 5 is a complex interaction from screen to motion, for example, following a 3D path projected on the screen). The above is included.

  c) The mental score includes one or more of the following: Challenges successfully completed in patient capacity and / or pain tolerance, self-assessment, total amount of reminder required by system, continuity of use (eg at home).

  In an exemplary embodiment of the invention, for example, using a database of similar injuries or using scores of multiple patients rehabilitating at the same time, patient scores are relative to other patients. Attached. Alternatively or additionally, scoring is performed between healthy and unhealthy limbs.

  In an exemplary embodiment of the invention, score scoring is used to aid diagnosis. In an exemplary embodiment of the invention, when diagnosing a patient, scores are scored for the ability of individual body parts and for overall ability (eg, by having appropriate training). In an exemplary embodiment of the invention, device 100 analyzes patient performance by performing tests and analyzing the results. In some cases, a series of exercises including two exercise types is performed to test which type of exercise the patient responds better. The results of the patient's performance are analyzed to extract a trend that indicates which controlled variable has a better or desirable effect on the patient. Optionally, the human therapist selects the initial possible training. Alternatively or additionally, the human therapist decides what percentage of time to spend on such training. The scoring method and granularity are adjusted by the therapist for each patient condition, for example, by adjusting the measurement accuracy, the dynamic range of the score, or the expected results (eg for quantitative measurements).

  In an exemplary embodiment of the invention, the patient may show an increase in strength score, but may not show a corresponding increase in accuracy (the correspondence may be, for example, according to a table or from the same patient, perhaps the same limb) According to the previous trend). In such cases, the patient's training plan is modified to include more focused training and less muscle build-up training. It is noteworthy that not all rehabilitation plans aim to improve multiple indicators simultaneously. In some plans, one indicator is focused, and once the desired improvement is achieved with that indicator, another indicator is focused.

  In an exemplary embodiment of the invention, the ongoing score is used to assess the time to reach a goal. Optionally, such assessment is based on one or more of the following: motivation, innate ability, and current disability. Optionally, innate ability is assessed by tracking the progress. Optionally, a series of results and estimated times for different situations are stored in a database and used to create an evaluation. Optionally, a neural network is used. Motivation is optionally evaluated using methods such as those described below. As an alternative, a manual assessment is provided. Optionally, the time evaluation also includes various score thresholds to be satisfied. For example, a certain evaluation is conditional on a certain level of motivation being maintained. Detection of reduced motivation can be used to provide instructions for updating the prediction process and to propose certain treatments.

[Home use]
In an exemplary embodiment of the invention, device 100 is adapted for home use. Such adaptation includes one or more of the following features.

  a) Small size. For example, the floor area occupied by the device 100 is less than 1 square meter. Optionally, device 100 is sized to pass through a standard doorway (eg, 60 cm, 70 cm, or 80 cm wide).

  b) Simple interface. In an exemplary embodiment of the present invention, the device 100 includes, for example, fewer options, instructions and / or feedback in diagrams and languages designed to be understood by a standard adult, and / or feedback to the user. Has a simple interface. In an exemplary embodiment of the invention, a wired or wireless pendant or watch-type control device is used. For example, the control device has a limited instruction set, a training selection dial, a button for selecting a test run or a low speed training mode, a start button for starting or stopping training, a slide volume for increasing or decreasing the difficulty of training or It includes a set of buttons and feedback LEDs or a liquid crystal display (e.g. defective red LED, good green LED). In an alternative device embodiment, device 100 is voice activated and is controlled using, for example, an IVR (interactive voice response) type menu system.

  c) suppleness. In an exemplary embodiment of the invention, the device 100 can be used by a variety of size patients (or living people) to perform a variety of treatments, various body parts and / or appendages (eg, 1, 2, 3 or 4 limbs). Designed to be used for limbs, or body parts, or others). In some cases, a variety of attachments are provided. Optionally, the device 100 is adapted for placement in various orientations and / or close to home activities and / or activities of daily living (eg, at a table for feeding rehabilitation).

  d) Unfixed. In some embodiments of the present invention, the device 100 is simply fixed to the surface or not fixed at all for ease of installation and removal.

  e) Mobility. Detailed below.

  f) Other home environments are optionally supported, for example, when the patient is in bed, in the living room, in the backyard.

  In an exemplary embodiment of the invention, device 100 is connected to a household appliance such as a television or a WiFi system. In an exemplary embodiment of the invention, the patient can receive instructions from the television, or the user can play with the system using the television as feedback. In another example, a set top box is utilized as a local processor and / or as a communication port to a remote station.

  In an exemplary embodiment of the invention, usage consists of the fact that the device 100 is at home and is located in a convenient location for the patient to use multiple times a day. In some cases, rehabilitation activities are planned to cover the majority of the day (eg, all day or half day), while allowing non-rehabilitation activities to live on the one hand, but not possible in a treatment facility. . For example, a rehabilitation plan can require a 5 minute session spanning the entire day at 1 hour intervals.

  In another example, as detailed below, the device 100 cooperates with a patient performing real life activities and / or using real life objects. This allows a rehabilitation plan that guides (and achieves) the actual progress of the patient's ability to deal with real life situations, particularly eating and dressing.

  In an exemplary embodiment of the invention, devices in separate homes are interconnected, for example, between family members and friends. Optionally, one of the participants is using a computer rather than device 100 (eg, using mouth movements to compete for device manipulation or using a standard computer interface for game players). Have a dialogue.

  In an exemplary embodiment of the invention, device 100 communicates with an outpatient clinic so that home activities and clinic activities are synchronized. Optionally, the patient carries a storage element (eg, USB memory card) containing his personal data.

  In an exemplary embodiment of the invention, the home system issues a prompt (eg, voice, email, or SMS prompt) for the patient to train.

[Remote use]
As described above, the device 100 is optionally used as part of a distributed system. FIG. 2 shows an exemplary distributed rehabilitation system 200.

  A house with one or more rehabilitation instruments 100 is shown. For example, a network 202 such as the Internet, CATV network, mobile phone network, or telephone network connects the device 100 to a remote site. In an exemplary embodiment of the invention, the remote site is a rehabilitation center in which a computer station 204 with a display 206 and user input 208 is located. One station 204 can optionally monitor multiple devices 100 in real time. Multiple stations 204 are provided at the same or different sites. Optionally, multiple stations 204 are used to monitor one device 100. For example, each device 100 is subject to a low level of supervision by a semi-skilled person who will manage or report a number of unskilled persons to the relevant supervised supervisor if there is a difficult problem.

  Also shown is an optional portable connection 212, for example using a laptop computer.

  Also shown is an optional remote database 210 that stores data for one or more patients (eg, 100 or 1000 patients). In some cases, the database is distributed, for example, at a rehabilitation site and / or device 100.

  In an exemplary embodiment of the invention, groups of patients are collected in a network based on similar (or overlapping) diets, treatments, and / or prognosis, and / or by affinity. In an exemplary embodiment of the invention, the progress of the members of the group is disclosed to other members, possibly driving competition. Support groups are provided for patients with low motivation. For example, in some groups patients are more advanced than others, and in some groups collective actions are performed instead of competition.

  In an example of a group activity, each of a plurality of patients has a role in a role playing game. The difficulty of each patient / role is set by the patient's capabilities. A group leader may be elected. In another example, each player is required to copy the group leader's exercise and / or instructions. Optionally, each player is protected by the device 100 so as not to overdo it.

  Other types of users can, for example, a patient's general practitioner, family member, or caregiver log on in addition to a supervisor to check the patient's progress.

  Remote rehabilitation can follow one or more of the following multiple paths, for example.

  a) Real-time monitoring. Optionally, a camera 214 is provided adjacent to the device 100 so that the therapist can sense the problem and / or advise the patient. Optionally, the data is analyzed by the therapist in real time. Optionally, real-time restoration by animation software or VR (virtual reality) is used. As an alternative, offline analysis is provided. Different payment schedules are provided for different types of monitoring. Furthermore, various rehabilitation needs suggest the level of interaction between teletherapists and patients. Optionally, the camera 214 can be controlled by the therapist, for example, to zoom and / or pan to a specific part of the patient. Optionally, the camera path is pre-planned to track planned and / or actual movements of various points on the patient and / or the patient's body. As an alternative or in addition to the camera 214, real-time monitoring is provided by various position and orientation sensors associated with the device 100. This requires less bandwidth than video surveillance.

  In an exemplary embodiment of the invention, for example, using an audiovisual method, for example to increase force or to change trajectories, or to keep the patient from exceeding safety limits, And / or by instructing the device 100 to respond in a certain manner, the therapist can provide real-time feedback.

  b) Live broadcast started. Monitoring is stopped once the rehabilitation session is started live (eg, while filmed) and once the therapist is confident that the patient can work on his own. Optionally, the patient can ask for help, for example during or between activities.

  c) Planning. A plan including training and / or programming for the device 100 is provided by the remote site weekly or at the start of each session. In some embodiments, planning is automatic and optionally performed with or without patient input to the device 100.

  d) Monitoring. The remote site can specialize in analyzing data uploaded from the device 100 or another location and suggest changes. For example, another type of monitoring can be performed to ascertain how regularly the patient uses the system and / or to respond to complaints. The rehabilitation center can, for example, perform weekly screenings and, in some cases, require periodic tests. Optionally, the patient is called to come to a rehabilitation center, for example, for testing, guidance, and / or additional treatment.

  e) Test. In an exemplary embodiment of the invention, the remote site uses the device 100 to test the patient and evaluate the patient's condition and / or progress. In an exemplary embodiment of the invention, such tests are utilized to assess drug efficacy and / or other treatment prescribed to the patient. Optionally, regular testing is used to select the most beneficial medication for Parkinson's disease patients or for convulsive patients.

  f) Home therapist. In some embodiments of the invention, the therapist comes to the patient's home for a rehabilitation session. For example, the therapist can set up the device 100, mark the correct starting position, adjust the device 100 for a particular patient (eg, size), and / or teach the patient how to use the device 100. Optionally, the therapist can access and / or contact a remote site, eg, seeking advice and / or monitoring of his work. When the therapist comes in a subsequent session, the remote site can help, for example, compare current and past performance. Optionally, the therapist brings device 100. Optionally, the therapist brings two devices. Optionally, the device brought in by the therapist is used to control a rehabilitation instrument already in the patient's home.

  g) Remote maintenance. In an exemplary embodiment of the invention, the device 100 may, for example, report technical issues with the device 100, remotely test the mechanical capabilities of the device 100, with or without patient assistance, log download and upload, and / or Or, maintenance can be received from a remote location, including one or more of software downloads and uploads. Optionally, device 100 collects billing information by remote access. Optionally, the device 100 collects usage information that can be used, for example, by an insurance company. In some embodiments, remote access to the device 100 can be performed by, for example, hiding the patient's personal information, limiting access to various logs and records, and / or utilizing passwords or other authentication schemes. Designed to maintain privacy.

  h) Remote motivation session. In an exemplary embodiment of the invention, the device 100 is used to sense a reduced motivation level and an on-site therapist (optionally arranged in the unlikely event) provides on-site encouragement and / or guidance. can do. In general, a real remote session is provided.

  In an exemplary embodiment of the invention, a virtual reality method (eg, goggle mounted display) is provided at a remote location to assist the remote operator with more control. Alternatively or additionally, the operator can manipulate his viewpoint. In an exemplary embodiment of the invention, the patient model is moved utilizing various sensors (eg, as described below) for remote and / or field feedback.

[Other usage]
The device 100 is used in some embodiments in a manner different from that described above. For example, in one embodiment of the present invention, a supervised group is provided. In a supervised group, one or more therapists observe / monitor / support multiple patients, each using a separate device. In such supervised groups, one or more of the following scenarios are implemented.

  a) Carrying-The therapist brings multiple devices 100 to a civic center, a nursing home, etc. and directs a session to a user group.

  b) Game-Each patient plays a role in the game and scores. In an example of an adventure game (eg, a role playing game), patients may earn life points, weapons, abilities, and other items by using rehabilitation training to improve their abilities. it can. The game is personally adapted to one or more patients, for example by providing assistance to the patient in need. In an exemplary embodiment of the invention, the game requires the patient to perform certain physical activities. The activity may vary between patients depending on the patient's need for rehabilitation. VR or simpler display technology helps to help patients become enthusiastic about the game and reduce their focus on other players. Such games can be played when patients are distributed and interconnected by a network such as the Internet.

  c) Call-in groups—Patients can join existing groups or games or sessions to form a virtual “treatment room”. Optionally, a chat line is provided at the same time as the rehabilitation training. Optionally, a rehabilitation server is provided to connect to the device 100, register requirements, establish connections to other devices and / or control access to the therapist.

  In an exemplary embodiment of the invention, the group is supervised by a therapist who can monitor the group using, for example, a webcam. Alternatively or additionally, patient training can be reproduced on the therapist's system using VR or simulation. Alternatively or additionally, the therapist can review the data generated by the system, such as a score. Optionally, different levels of interaction between the therapist and the patient may be provided, for example based on a payment plan. In one example, a live connection is only available to high-pay patients. In another example, the webcam interface is only available to high-pay patients. Similarly, the payment plan may contribute to other parameters of treatment (eg, training complexity, inspection level, patient interaction, and audiovisual effects and / or game characteristics). Optionally, the amount of rehabilitation actually provided by the system also depends on the payer. Alternatively or additionally, the payer is charged according to the rehabilitation performed.

  d) Testing and / or Training-In an exemplary embodiment of the invention, the therapist uses groups to test new therapy ideas on a trial basis and discuss relative benefits and issues for various methods. Get real-time patient feedback. Optionally, utilizing the group for training purposes, for example, allows the therapist to observe multiple patients substantially simultaneously, under the same and / or different conditions. Optionally, if a difference is observed, the therapist can be trained to identify the difference and / or know how to rehabilitate by distinguishing the difference.

  In an exemplary embodiment of the invention, a linked system scenario is executed. In one example, two devices are connected by a master / slave relationship using, for example, a wired or wireless connection (eg, Bluetooth, mobile phone, or WiFi) or a network connection. For example, a master can be an older parent who has a son (or daughter) and a slave who helps the son to rehabilitate. This allows rehabilitation training to be used as a means for parents with paralysis to maintain contact with their families. Alternatively or additionally, parents with paralysis can receive support from their families. Such support includes advice on how to use the system and what kind of training to try.

  Another exemplary use of the linked device 100 (or one device with multiple arms 102) is for children's play. In an exemplary embodiment of the invention, a child with paralysis plays with a healthy child by maneuvering a separate arm or device. Optionally, the athletic ability of a child with paralysis is supplemented by the device 100, for example, providing speed enhancement or providing periodic automated behavior. When a child plays a role-playing game or a sports simulation (eg tennis), the device 100 allows the paralyzed child to have partial control from the beginning to the end of the game (eg, substantially for paralyzed children). While being able to perform 20% of the movement), it can complement the ability of children with paralysis. The device 100 can adjust the support level to ensure equal competition conditions for children with paralysis.

[Feedback and patient user interface]
Various types of feedback are envisioned for use in one or more of the following, for example, according to exemplary embodiments of the invention.

  a) Patient feedback. Optionally, the patient can provide feedback to the therapist, for example using voice annotations or text annotations. In one example, such feedback is provided during the activity. In another example, the patient reviews the activity record before adding a comment. In some activities supported by exemplary embodiments of the present invention, the patient is required to operate the controller when certain conditions (eg, maximum force) are established. Feedback is also provided by the patient for planning or progress, not just for each individual's activities.

  In some embodiments of the present invention, patient feedback is processed by the device 100 to modify and / or determine current or future activities and / or their parameters. For example, if a patient pays attention that a certain force is a maximum force, further activity will not exceed that force. In some embodiments of the invention, no explicit user feedback is required; instead, the system clearly determines when the maximum force is approached, for example based on control difficulties. In this way, we can make a prototype of future activities with the determined power.

  b) Patient feedback. In an exemplary embodiment of the invention, feedback is presented to the patient, for example during activity, during a break, and / or after activity. For example, such feedback may indicate to the user that he is performing inaccurately, that future cycles should be done in different ways, and / or current and past performance and And / or other statistical comparisons. It should be noted that in many cases, positive feedback is as important or more important than negative feedback. This depends on the rehabilitation therapy used. Positive feedback can be, for example, voice encouragement, applause, pleasant video, and / or score increase.

  Various feedback modalities, such as language and audio feedback, displays including text or images, marked video images, force and vibration feedback (eg, by tip 108) to device 100, are separate factors (described above). For example) and / or virtual reality devices (such as goggle-type displays). In a virtual reality device, the type of error (or correct activity), location, and / or other parameters are shown superimposed on a video of real or virtual activity.

  For example, US Provisional Patent Application No. 60 / 633,429 filed Dec. 7, 2004 (also PCT application by the same applicant as the present application (title “Rehabilitation with Music”, agent case number) 414/04396), the disclosures of both applications are incorporated herein by reference), particularly for patients with limited cognitive, language and / or visual ability. , Music may be used as a feedback style. For example, music can be used to inform the characteristics of exercise, music can be produced by exercise, or music can be used by the device 100 as an instruction or signal to a patient.

  c) Feedback to the therapist. In an exemplary embodiment of the invention, a local or remote therapist is provided with feedback. Such feedback may include, for example, the degree of use (eg, whether the patient continued training when the therapist did not pay attention), strength level, indication of error, lack of / exceeding certain parameters, One or more of notifications of conformity, predetermined alerts, exercise characteristics (described below), safety status, and / or current and / or historical statistical analysis are included.

  d) Feedback from remote therapists. In an exemplary embodiment of the invention, feedback received by a patient, for example as shown above, is provided by a remote therapist. Optionally, such feedback includes an indication to device 100 whether to repeat certain exercises and / or modify parameters. In an exemplary embodiment of the invention, training is delimited by breakpoints that the therapist can add. At the breakpoint, the therapist, patient and / or device 100 (according to the example), for example, force a break if changing future parameters and / or repeat the activity if the desired result is not achieved. Such breakpoints are not determined by the patient and need not be noticed by the patient if the determination is made fast enough or during a short predetermined break.

  e) Feedback from device 100. Depending on the automation level of the device 100, for example, feedback is provided by the device as to whether a threshold has been exceeded or a safety issue has been indicated.

  f) feedback from attached sensor patches or image analysis of the patient and / or device 100; An exemplary such patch is described below with reference to FIG.

  g) Feedback from one device to the other, eg operation in master / slave mode.

  In an exemplary embodiment of the invention, the language is part of the rehabilitation process. In one example, device 100 responds to or requests a voice command. In another example, the device 100 generates a voice indication.

  For some users, a simple interface is required. In one example, the instruction to the user (patient) to indicate start / stop is a simple red / blue light.

  Multiple different types of cues, such as, for example, auditory, tactile, vibration (device 100 or patch), reverse limb movement, visual (eg, blinking screen), and / or changing speed, Provided to indicate that patient activity is required.

  In an exemplary embodiment of the invention, a dummy body is used to show the patient the effect that movement of the device 100 (eg, arm 102) has on the patient.

  Optionally, as the patient's rehabilitation progresses and the patient's cognitive performance improves and / or attention is directed more to the spare, the complexity of the interface used is increased. Optionally, a user interface is utilized to perform simultaneous cognitive, perceptual and motor rehabilitation, for example as described below. For example, by selecting an interface that was adapted to the patient's ability and / or by training the patient for certain non-motor activities.

[Mental state]
As mentioned above, the course of rehabilitation for any individual patient generally depends on one or more of the following: Cognitive ability (if the patient cannot think clearly, exercise planning is difficult or impossible ), Intelligence (rehabilitation is difficult if the patient has no motivation), and motor skills.

  In an exemplary embodiment of the invention, one or more of these are measured and / or supported by the device 100. Optionally, the change in the degree and / or type of assistance is determined by system 100. Alternatively or additionally, support changes are determined by the user, or a plan for how to change support according to the score is set by the user.

  Cognitive support can be provided, for example, by providing simple displays, multiple modes of information presentation, reminders, cues, and / or multiple cues. Cognitive ability is tested, for example, by giving a test or running a game that requires cognitive ability. In some cases, there is a distinction between cognitive ability and perceptive ability.

  In an exemplary embodiment of the invention, a patient is required to perform an exercise task (eg, moving forward), and his ability to understand his task depends on cognitive skills. The ability to see a target on the screen or actually receive an indication (eg, visual or verbal) depends on his perceptual ability.

  For example, the support of athletic ability is based on the various exercise modes described above, for example. For example, measuring athletic performance is by providing training with a standard range of results and evaluating the results on a known scale.

  In assisting mental states, various methods are provided in some embodiments of the present invention.

  (A) The device 100 (or remote controller) can take the initiative on behalf of the patient, for example, leading exercise and leading training iterations.

  (B) The device 100 can provide inspiration, such as a score and special feedback elements (images, jokes, funny icons, laughter, and / or break time, etc.).

  (C) The device 100 can support groups. In groups, members provide motivation to each other, for example, through cooperation and competition.

  (D) The device 100 can provide a game.

  (E) The device 100 can point out a lack of motivation that suggests the need to provide comfort.

  (F) The device 100 reduces safety features and / or pain (e.g., the user indicates the pain range and the device 100 only limits the pain range when the patient has been warned in advance). Presenting features designed to increase patient motivation and reduce fear. In an exemplary embodiment of the invention, the user indicates the extent of pain to the device 100 by pressing the controller when the user reaches the point of pain, or by the therapist doing so. For example, more specific pain sensors that detect neural activity and physiological changes such as sweating and increased pulse are also used.

  (G) The device 100 can selectively provide positive feedback or negative feedback.

  (H) The apparatus 100 can be set up and down somewhat, allowing for errors.

  (I) The device 100 can track which training is likely to cause more motivation and / or coordination to the patient.

  (J) The device 100 pays attention on behalf of the patient, for example, continuing attention to ensure that the exercise once started is accomplished. If a mistake occurs, the device 100, which is required to be aware of the mistake on behalf of the patient, finds the mistake and gives a signal to correct the movement. This reduces the mental and cognitive burden on the patient.

  Although motivation and other mental states (such as depression and withdrawal) are evaluated by humans, in an exemplary embodiment of the invention, by detecting the impact on these performances, the device 100 Measured or evaluated by In an exemplary embodiment of the invention, device 100 evaluates, for example, one or more of the following: how hard a patient works, how well a patient accomplishes a task, during and between sessions Course, response to expected stimuli, and / or variability between various tasks and / or within a task.

  In one measurement method, the patient's performance in the task is compared with the patient's performance (joint range, speed accuracy) in the game. Under the assumption that playing a game will increase motivation, the difference in performance between the game and training may indicate the degree of motivation difference between a desired task and an undesired task.

  In another measurement method, the device 100 is used to measure a range of patient capabilities, such as ROM (range of motion) and pain limits. A diagnostic session is considered reliable to provide relatively accurate information about the patient's capabilities, at least because the patient understands that the scope of the diagnostic session is limited . Thereafter, training at the limit of the patient's ability is provided to the patient, and the number of attempts and successes that reach the limit of the range is measured. This measurement result is used as an indicator of motivation (eg, willingness to achieve what the patient knows can be achieved). In an exemplary embodiment of the invention, the training includes giving the patient a goal of performance and the patient is expected to strive towards the goal.

  In another measurement method, a self-calibration method, the patient plays a game where some of their goals are within the patient's capabilities. Understanding that this ability has not progressed provides a variety of goals of varying difficulty. In an exemplary embodiment of the invention, motivation is a game for measuring firstly what a patient's ability is and secondly how many times the patient tries to reach the limit of ability. It is evaluated by analyzing.

  Another method of measurement is to track how hard the patient works (eg, how much rest time is). Another method is to determine that the patient is most committed to any particular training. Another method is to ascertain whether the patient has provided attention, enthusiasm, and / or effort in a free play session that can be trained when desired by the patient at any difficulty desired by the patient. Attention is optionally determined by comparing trajectories at different times, for example, by examining the range of variation (eg, if the patient suddenly slows down-perhaps he is distracted) . Enthusiasm is optionally determined, for example, by tracking changes required by the patient in training where the patient can select one from several trajectories.

  In an exemplary embodiment of the invention, handwriting and gross motor activity (e.g., detection of abnormal tremors, signs of tension such as ticks, and / or lack of control, e.g., compared to other times) are analyzed. The mental state is evaluated. It should be noted that mental states are in some cases provided as relative states rather than absolute values.

[Training]
In an exemplary embodiment of the invention, existing physical rehabilitation training is used for the device 100. However, various means that are not currently available may be provided. In some cases, training is modified to account for device 100 limitations or device 100 capabilities. Optionally, the correct motion is determined with accuracy and / or degree of control and probably not determined manually. Furthermore, some of the training described here (or other techniques described herein) cannot be performed without the assistance of a robot.

  In an exemplary embodiment of the invention, the training is modified manually. In an exemplary embodiment of the invention, the training is recorded by the therapist and then annotated (eg, to mark a desired measurement result). In another example, training is programmed directly into device 100. Optionally, device 100 suggests limitations (eg, safety limits or device limits) or additions to training and / or where less support or more support exercise modes are appropriate ( For example, at the end of the operation, a more support mode is desirable).

  In an exemplary embodiment of the invention, reaching training is performed by the patient. In such training, various muscle groups can be trained and various difficulty levels are provided.

In an exemplary embodiment of the invention, the reaching movement is defined by one or more of the following exemplary parameters.
Reach distance:
Near-in contact with the body or a few inches away from the body Moderate-Intermediate range from full extension to closed distance Far-almost full arm extension Direction of arrival:
Up / Down-From a higher (lower) reach to a lower (higher) position Outside / Inside-Moving away / toward the body Lateral / Near-Moving laterally away / from / to the body Reaching height:
Overhead Eye height Shoulder height Torso height Goal:
Free reaching-Movement to a general position in space without a target Goal reaching-Movement to a physical target Pseudo target-Movement to a target shown on a computer screen

  In particular, this “arrival” is defined by the start position, and the end position of the hand is defined by the distance, direction and height. Optional reach may be further understood by the involvement of the arm joint and the patient's ability to distinguish the joint to achieve reach.

In an exemplary embodiment of the invention, one or more of the following measurements are defined:
Patient's ability to reach Movement smoothness Time to reach end point Arrival accuracy Accuracy of work or work done Comparison of movement trajectory with normal trajectory pattern of reaching movement Stability of performing repetitive movement

  In an exemplary embodiment of the invention, reaching training consists of the following general steps:

  5-10 iterations reached under guided movement. The patient is instructed to attempt to move with the device 100.

  5 to 10 iterations of lead mode. The magnitude and direction of the patient's force is measured by the device 100. When the threshold for correct intent is exceeded, the device 100 guides the patient to accomplish the arrival.

  5-10 iterations of assist mode. The patient attempts to perform the reach on his own. The device 100 determines the intention and assists the patient in moving. Over time, the amount of assistance is reduced so that the patient can move more independently.

  5 to 10 repetitions of free movement. The patient attempts to perform an arrival without assistance from the device 100.

  Another exemplary training is imitation of daily activities, such as moving a full cup between two points or lifting a book.

[programming]
In an exemplary embodiment of the invention, various aspects of the rehabilitation process can be planned and input as instructions to a computer (eg, device 100), including one or more of the following.
a) designing new training,
b) modify training for specific situations and / or patients;
c) planning and modifying rehabilitation plans; and d) designing and modifying decision logic (eg, breakpoints, thresholds, and number of iterations).

  Permissions for different users of system 200 and / or apparatus 100 may be different. For example, different permissions may allow one or more of new matter addition, duplication, modification, deletion, and / or editing. These activities may be directed to one or more of patient data, activities, plans, statistics, and / or data logs, for example. Specific activity parameters created and / or modified according to exemplary embodiments of the present invention include: trajectory, position and range (eg, minimum and maximum speed and angle); force parameters The number of repetitive cycles, the number of stop decisions, and / or the length and frequency of breaks.

  In some embodiments of the invention, one or more libraries (eg, planning libraries, patient-specific libraries, and / or activity libraries) are provided as a basis for program modification and storage.

  In an exemplary embodiment of the invention, a new trajectory is entered by physically manipulating the tip 108 (eg, by the patient's normal hand or by the therapist). Optionally, the resulting trajectory (s) is then edited on the computer. Alternatively or additionally, a three-dimensional CAD / CAM program is used, optionally one of which can model the human body, place various constraints on the movement of points on the body, and / or Or a desired or acceptable range of motion for such a point is defined. Optionally, a graphic design program is used (e.g., the user indicates a few points on the trajectory and the program finishes with a straight line or curve). Alternatively or additionally, the user can define various geometric shapes, such as circles, by providing points and / or functions. Alternatively or additionally, a user can draw a line and scan into system 200 (eg, at station 204 or device 100) with a scanner.

In an exemplary embodiment of the invention, training is modified for a particular patient and / or situation. The modifications may include, for example, one or more of the following:
a) Modifications to the range of joint angle of trajectory or the ability to apply force or precisely position control;
B) Correction to patient size (eg, limb or bone length);
C) Correction to progress. For example, a plan may have a plan time span and / or step size that is modified based on a shown or predicted course.

  As described above, trajectories performed by the patient or by the therapist may be compiled and used for training. In an exemplary embodiment of the invention, editing includes one or more of smoothing, adding points and / or path segments, converting motion to basic motion elements.

[Programming language examples]
Table 1 below describes an exemplary high-level programming language that is optionally used to program the device 100 instead of learning the robot programming language. In an exemplary embodiment of the invention, this language is used by the therapist and / or other users. Optionally, the current training can be saved and modified.

  This high-level language is based on a library of icons (each of which corresponds to a command) that can be dragged into the program area to build (or edit) a program. Each icon represents a command, and three types of commands are defined (and may be added more).

      a. Movement commands-Basic movements such as linear movement and circular movement. Each command has a start point (P1) and a stop point (P2), and the speed, force, and acceleration / deceleration time can be set for all motion commands. The point (P1, P2) can be set by pressing an input key while the tip end portion 108 is located at a desired point.

      b. General commands-start / stop of program, delay, recording, etc.

      c. Auxiliary Command-A command set that operates external devices and accessories that can be attached to the device.

All commands have an input parameter set (otherwise the initial parameters are used). An operator can add a comment to each command. The device 100 creates a description for each command and the operator can add comments to all commands. And all commands have explanations. The commands for instructing the user and the parameters for defining what action the device 100 takes under certain conditions are not shown in the table. Optionally, each path segment may include one or more triggers that, when activated, execute a short piece of code. One example is a trigger that works when the user changes his speed by more than 10%, in which case a warning is given or a more auxiliary mode is provided.

  Table 2 is a sample program using the language shown in Table 1. The program structure has a plurality of columns, where the first column is a sequential main command and the second and third columns are for commands operating in parallel.

  When starting a new program, start and stop commands are optionally provided automatically. Other commands are inserted manually between start and stop.

Table 2 is a sample program of a path composed of three straight lines (which may be a right angle). There is a delay between each straight line, and the external device is activated during the second straight line (eg, waiting for input from the handle). All data for the second and third straight lines are recorded and the entire program is repeated five times. Corrections to iteration (eg, increase speed and increase required accuracy) are optionally provided as parameters. General program parameters (eg score scoring type, expected exercise characteristics) are optionally provided

  A special type of control provided by some embodiments of the present invention is spatial programming control. In this type of control, a certain gesture or position of the tip 108 in space is translated into a command for the device 100. In one example, such a gesture is used by the therapist or patient to fast forward after the training session.

  In another shortcut example, the therapist's wrist movements are translated into arm (or other limb) movements. This allows the therapist to make smaller movements (and not just the limbs of the programmed exercise).

[Detection and control of limb position]
In the device 100, as will be explained, only one point of the patient in contact with the tip 108 is controlled. However, this means that several different arm movements can result in the same trajectory. For some situations this is not a problem. For example, in some cases, any exercise is beneficial for recovery from stroke. In other rehabilitation scenarios, it is desirable to determine and know in more detail the location of all moving body parts. In some exemplary embodiments of the invention, other body parts are fixed. For example, the patient is secured to a chair with a seat strap (eg, the patient's shoulder) and / or an elbow support (rest) is provided. This limits the possible movement by the hand holding the tip 108.

  FIG. 5 illustrates a system 500 incorporating limb position sensing and / or restriction, according to an illustrative embodiment of the invention. Correct movement of a body part other than the hand that contacts the tip 108 is provided, for example, by detecting position and providing feedback (eg, audio or visual feedback) to the patient.

  The patient 506 sits on a chair 514 and uses the device 100 (or a device with an arm attached to a ball, as described below). One or more cameras 502 image the arm and / or other parts of the patient 506 and determine their spatial position and / or velocity. Alternatively or additionally, one or more cameras 516 are installed in the apparatus 100 for similar imaging. In some implementations of image-based postural restoration, it may be beneficial to incorporate one or more fiducial markers 504 (eg, strapped patterns or LEDs).

  As an alternative to image-based position sensing, magnetic, electrical, ultrasonic, or other non-contact position and orientation sensing methods can be used. Many such location determination methods and devices are known and probably used. In an exemplary embodiment of the invention, the reference position is provided on the device 100 and / or on the tip 108. Optionally, the position sensor is used to determine the state of the device 100 instead of or in addition to the mechanical sensor that the device 100 comprises.

  As an alternative or in addition to the use of non-contact position sensing, mechanical position sensing using, for example, articulated arms can be utilized.

  In some embodiments of the present invention, it should be appreciated that instead of using some type of position sensor, no arm 102 is provided. Feedback is optionally provided via a virtual reality type display and feedback (eg, vibrations to mimic forces). However, this may not allow direct applied force feedback or resistance as required in other exemplary embodiments of the invention.

  In an exemplary embodiment of the invention, patch 504 is used to provide feedback and cues to the patient. In an exemplary embodiment of the invention, the patch comprises a wireless receiver, an optional power source, and a stimulator (e.g., a vibrator, a pin stick, a pincher, or a heating element). A command from device 100 can cause patch 504 to provide stimulation to the patient. The patch 504 may be wired instead of wireless.

In an exemplary embodiment of the invention, the detected body point location is utilized for one or more of the following.
a) Determine if the physical movement is correct b) Determine what movement is possible (eg based on joint angle) c) Learn the desired movement from the case d) Observe the patient's ability ( (E.g. for testing and limb assessment) and / or e) determining whether the body posture is correct during training, before training and / or after training and when changes occur.

  In lieu of or in addition to position, orientation, and velocity sensors, physiological sensors (e.g., pulse measurement sensors known in the field of training equipment, grip force and / or pinch force sensors built into the tip 108, One or more). Alternatively or additionally, one or more physiological sensors (eg, respiratory frequency sensors) are attached to the patient.

  Returning to FIG. 5, a body rest 508 is provided for one or more body parts in place of or in addition to the position sensor. In the illustrated example, a rest 508 attached to the chair 514 by a bar 510 (optionally adjustable) suppresses chest and / or shoulder movement. In an alternative embodiment, one or more straps are used to hold the body part.

  In an exemplary embodiment of the invention, inverse kinematics is used to estimate motion and / or patient joint and / or bone dimensions. For example, if the limb is secured to the rest 508, the motion of the tip 108 can be used to evaluate the actual joint motion. If the brace 508 used to secure the elbow is in a fully extended position, the distance from the shoulder to the wrist when the patient is moving the arm can be calculated. When the handle of FIG. 15F is used and the patient is limited by the shoulder brace, the forearm length can be determined. Alternatively or additionally, force fields can be used to limit movement so that limb dimensions can be reliably determined.

  In an exemplary embodiment of the invention, a patient model is created for use in such inverse kinematic calculations. Such a model can also be used in the safety calculation. For example, if the patient can reach a joint arrangement that is dangerous to exercise, dangerous exercise is avoided. The reach of each joint may depend on, for example, patient fixation (eg, orthosis), measured ROM, and assumed ROM.

  Optionally, chair 514 is secured to device 100 using securing bar 512, for example, in an adjustable manner. Optionally, an initial adjustment process is performed, for example, when initially performing a new activity or during device setup. In one example, the bar 512 has a scale, and the correct chair placement relative to the scale is measured during adjustment.

  In some embodiments of the invention, the device 100 carries a built-in chair 514. An exemplary arrangement of the movable chair is described below.

  In an exemplary embodiment of the invention, the positioning detection accuracy should be better than 1 cm, 5 mm, 2 mm, or 1 mm over the entire range of movement of the device. In some embodiments, lower absolute positioning accuracy is allowed if relative accuracy is maintained during training.

  In an exemplary embodiment of the invention, the accuracy of force control is 100 gr, 50 gr, 10 gr or less, or better. Optionally, the arm balance is within these numerical ranges. Similar accuracy is provided for measurements. Optionally, a sampling rate of 10 Hz, 50 Hz, 100 Hz or higher is provided.

[Patient positioning]
In some embodiments of the invention and / or training, the position of the patient is not important. However, in many exercises, precise targeting of certain joints, tendons, and / or muscle groups is the accuracy of movement of the tip 108 relative to the patient, and / or patient posture, and / or other body parts. Request.

  In an exemplary embodiment of the invention, a strap, brace, and / or rest 508 is provided for setting the position of the patient. Optionally, device 100 is provided with one or more bars 512 that couple to chair 514. As an alternative to the bar, the reference 512 is a spring-loaded wire that includes a position sensor to indicate the amount of retraction and thus the relative position of the chair 514 with respect to the device 100. Optionally, multiple retractable wires are used. Optionally, each wire includes a ring through which the leg of chair 514 passes. Optionally, if the chair moves during the session, the training is immediately modified to ensure a new relative position between the chair 514 and the device 100. Alternatively or additionally, if patient movement (eg, movement from one posture to another) is detected during a session, the training adapts to reflect the new position. Optionally, a plurality of typical static postures of the patient are learned, and the system uses these learned postures to distinguish the exercise being performed from the semi-permanent posture. Optionally, changes in posture are detected by changes in pressure applied to various pressure sensors, or using a chair / device and / or a camera that images the patient. Alternatively or additionally, the change is detected by detecting the actual activation change that the tip 108 follows.

  Optionally, a mat 518 is provided. In one option, the mat 518 is a pressure sensitive mat for sensing the position of a chair leg or patient leg. Optionally, adjustments are made to the chair that the patient actually uses. Alternatively or additionally, the mat can be used to allow manual entry of the relative position. Alternatively or additionally, the mat has a mark that is recognizable by the camera that photographs the mat.

  In the exemplary embodiment of the invention, tip 108 is used to determine the position of chair 514. In one example, the chair 514 is locked once in place and the tip 108 is used as a digitizer to contact the chair 514 and / or a point on the patient's surface. In some cases, a tip adapter is attached to the tip 108. Optionally, once the patient's position has been digitized (eg, under therapist's guidance), the next time chair 514 is brought into device 100, device 100 moves tip 108. , Indicate the desired position of the chair 514 or patient.

  Optionally, a laser or light pointer is attached to the tip 108 (or arm 108 or other part of the device 100) to mark the light at a desired position relative to the chair and / or patient body part. The apparatus 100 optionally converts the coordinate system of the pointing device, arm 108, and / or chair to each other.

  In some embodiments of the present invention, it is not the tip 108 but the patient's hand or finger that should be located at a certain location. Optionally, a dummy hand is placed in device 100 and used for such adjustment.

  Positioning methods such as those described herein can also be used to position other parts of the rehabilitation system (eg, table, glasses, second device 100, or a set of everyday equipment as illustrated in FIG. 19H). It should be noted that.

  In an exemplary embodiment of the invention, patient positioning is determined by patient kinematics. In an exemplary embodiment of the invention, once the patient is in place, the patient performs one or more exercises, and the patient's position is determined based on the trajectory actually followed. In some cases, it is necessary to know the patient's previous ability (eg, range of motion) in order to determine the patient's position.

  In an exemplary embodiment of the invention, the patient swings his arm without bending his elbow. The range of motion suggests the position of the shoulder joint. This information is optionally used if the patient is unable to stretch his elbow straight (or hold it straight).

  In an exemplary embodiment of the invention, it is assumed that the patient's movement during the session is primarily a translational movement in a two-dimensional plane, so only one movement of the arm is sufficient for alignment. . Optionally, the two arms move to assist in detecting body torsion.

  Optionally, instead of or in addition to determining the patient's position, an initial series of patient movements are used to extract basic information about the patient, such as range of motion and freedom of movement. Optionally, prior to taking measurements, device 100 first applies or proposes a series of exercises intended to warm up muscles and joints.

[Attachment (attachment to the body)]
In FIG. 1, the tip 108 is held in the patient's hand. Other means are used to attach to other parts of the body. In one example, instead of a ball-like handle, a strap or elastic ring is provided at the tip 108. In another example, a rod-like handle is provided instead of a ball-like handle.

  FIG. 6 illustrates an elbow holder 600 according to an exemplary embodiment of the present invention. For example, the elbow holder is used when the required motion is a shoulder motion and thus the elbow 616 moves along a trajectory. Base 602 is configured to attach to tip 108. The hinge 604 allows relative movement between the first portion 606 and the second portion 608 on which the arm 614 is placed. Optional straps 610 and 612 optionally attach arm 614 more securely to holder 610. Optionally, joint 604 has a variable resistance (eg, settable by patient and / or device 100). Alternatively or additionally, the joint 604 includes an actuator for providing a force to open and close the elbow 616. Alternatively or additionally, the joint 604 comprises an angle sensor. Optionally, the holder 600 can vibrate the elbow, for example, as a therapeutic effect or to help prevent joint contractures, which vibrations can be applied to other joints, eg, using a suitable attachment. It can also be added to body parts.

  In an exemplary embodiment of the invention, in one example, the holder 600 functions as a convulsion brace, the joint 604 is fixed (or not a joint), and the arm 614 is held open by straps 610 and 612. The

  In an exemplary embodiment of the invention, portions 608 and 606 are raised so that joint 604 has substantially the same center of rotation as elbow 616 in one or more planes.

  In other embodiments of the invention, attachments to other points on the body are provided. In particular, it is noted that what is restricted is bone or a certain location on the bone, while in some embodiments of the invention, what is restricted is a joint. As mentioned above, various types of constraints (eg, angle and / or spatial volume) are provided. The additional attachment will be described below with reference to FIG.

  In an exemplary embodiment of the invention, the attachment includes an encoding circuit or other means so that when attached to arm 102, device 100 recognizes the type of attachment.

  In some embodiments, the attachment is to a quick connect element consisting of two mechanical quick connect components (eg, a spring-loaded pin and slot combination) and an electrical quick connect (eg, a spring-loaded small needle contact). It is adapted and allows fast switching from training to training or from patient to patient. In an exemplary embodiment of the invention, each attachment has a semiconductor chip, receives power from the connector, and transmits data (if any) over a bus (eg, a packet bus). Alternatively, an electrical connector is used to connect the attachment measurement means (eg electrometer) directly to the device 100.

[Instructions for users]
The device 100 can provide instructions to the user in a number of modes, including one or more of the following (for various embodiments of the invention).
a) Recorded audio b) Computer animation display c) Instructional video d) Exercise of device 100 (patient does not participate)
e) Movement of the device 100 (with patient participation. Perform at low speed with explanations as much as possible.)
f) Movement of device 100 (with dummy)
g) Use of notes (eg as a cue or to set the tempo of exercise)
h) Movement of the second device 100 (eg as a demonstration or in the sequence of the patient's own movement)

[Quality of training, instruction and exercise (QoM)]
While part of a rehabilitation plan is often to train a body part to maintain or increase strength and / or range of motion, in an exemplary embodiment of the invention, rehabilitation is a qualitative exercise. Including instructing the patient on the side and / or what exercise is correct.

In an exemplary embodiment of the invention, the following one or more motion characteristics are important.
a) Utilization of available range of motion (of the joint or joints) b) Use of muscles that can exert sufficient force c) Joints and / or muscles to achieve higher precision control D) Movement that does not approach the threshold of ability e) Movement that does not approach the dangerous area (eg for patients with unstable joints)
f) Smoothness of motion and / or rotation g) Distance traveled h) Maximum required force i) Spatial and / or energy efficiency of motion (eg, excess motion)
j) Exercise with minimal spasm

  In an exemplary embodiment of the invention, motion characteristics are determined using power laws that characterize the motion of healthy individuals. A person with paralysis is optionally characterized in what joints and / or modes of movement they can approach this law.

  Optionally, “normal movement” is described by basic kinematic characteristics that define the characteristics of movement. For the arm, one such characteristic is the smooth movement of the hand from one point to another, following the approximately shortest path between the two points. The second characteristic is that the speed of the hand is limited by the curvature of the path. (Viviani P, and Terzuolo C. “Trajectory determines movement dynamics”, J Neurosci 7, 1982: 431-437, the disclosure of which is incorporated by reference into the present disclosure). The greater the curvature of the trajectory, the slower the hand movement at a constant rate of 2/3. These kinematic descriptions are mathematically defined, so they can be used for objective quantification of the characteristics of the movement.

  “Minimum spasm” can explain the characteristics of the smooth and shortest movements often observed in healthy individuals, and further demonstrates the relationship between path curvature and hand speed “Two Power Laws” have been clarified. Recently, both laws have been integrated (Viviani P, and Flash F. “Minimum spasm, two-thirds power, and coincidence: convergence approach to motion planning” “Minimum-jerk, two-thirds power law, and isochrony: converging approaches to movement planning. ”, J Exp Psychol: Hum Percept Perform 17: 32-53, 1995, the disclosure of which is incorporated into the disclosure of the present application by reference), as two aspects of the same concept Mathematically defined (Richardson MJE, and Flash T. “Comparing smooth arm movements with the Two-Thirds Power Law” “Comparing smooth arm movements with the Two-Thirds Power Law” ", J Neurosci 22: 8201-8211, 2002, the disclosure of which is incorporated herein by reference). These two laws, integrated into one description, can be used to test pre-treatment, during-treatment, and / or post-treatment motion characteristics with the device 100. Optionally, fitting to a power law is determined by applying a series of motions to the patient at various speeds and extracting the power law data from the results. The law may also apply to other joints and limbs (eg, lower limbs).

  Another law that may be applied relates to the relative movement of each joint in a coordinated movement. In healthy individuals, such movement takes into account the relative distances from the targets of the various joint movements and the various accuracies of the joints. Another law that may apply is the Fits law, which relates the time to hit the target and the size of the target.

  These characteristics may be common for certain exercises or may be special for patients with certain abilities and deficiencies.

  In an exemplary embodiment of the invention, such characteristics of exercise are instructed to the patient by example (eg, guiding the arm to correct and incorrect exercise). Such exercise may be entered, for example, by a therapist or patient or pre-programmed. Alternatively or additionally, the patient's movement is recorded and corrected, and the patient is tuned through an incorrect or corrected movement. In a predefined exercise, the exercise may be adjusted for an individual user (eg, for the user's size).

  Optionally, an accuracy threshold is defined in order for the patient to strive to keep all of the patient's movements (in one or more parameters) above the threshold.

  Alternatively or additionally, such characteristics are taught by real-time or offline comments on patient movement.

  Thus, in some embodiments of the present invention, knowing that a significant portion of rehabilitation trains the patient with the correct exercise, or whether certain exercises performed by the patient are of high or low characteristics Consists of teaching the patient how.

  Other types of training are not related to exercise accuracy. For example, a patient can be trained to not ignore a disabled limb. In a related aspect, however, the patient can be trained to use the impaired joint as part of a “correct” exercise so as not to reduce the range of motion.

  In one example, the relative motion predicted between the elbow and wrist for a certain motion, such as by moving an object on a table, is known (eg, or entered by a therapist by way of example). Feedback is provided when the patient deviates from a certain amount (eg, defined by the therapist).

[Anti-exercise]
In an exemplary embodiment of the invention, exercise with good arms is used for training bad arms. For example, a good arm can draw a circle, and a bad arm trains to draw a circle. One advantage of such training is the detailed feedback that the patient receives by better and accurately understanding which joints and muscles are used for each exercise. In an alternative application, “good” exercise is provided by a therapist or other caregiver.

In the single arm device 100, the following process is used.
a) The device 100 optionally describes the correct movement in a demonstration or on the display.
b) Exercise is performed by “good” limbs. Optionally, the motion is modified using methods as described above for editing.
c) The movement is repeated with “bad” limbs, eg using passive movement, free movement, or force field. Optionally, “good” exercise is corrected before application to a bad limb, such as reducing scheduled speed, reducing range of motion, and reducing force.
D) Feedback is provided to the patient during and / or after exercise (eg as a display)
E) The movement is optionally repeated.

  7 and 8 show two handle devices 700 and 800 that allow two arms to move simultaneously with an optional coupling. In an exemplary embodiment of the invention, the handle is used to move one arm in a passive manner with one arm. So, for example, a patient can feel what a bad arm is doing with a good arm, and vice versa. Alternatively or additionally, one handle is moved by the device so that the patient knows what he is looking for. Optionally, a two-arm device is used for children, for example as a game between a paralyzed child and a healthy child or adult.

  Two separate rehabilitation devices 702 and 704 are optionally attached by a base and are electrically and / or mechanically coupled by a computer so that one arm 708 mimics the movement of the other arm 710. . The mechanically moving arm is optionally a ball-type mechanism which will be described later.

  In device 800, one joint connects two arms 808 and 810. As a result, the motion is reversed. Optionally, arms 808 and 810 are extensible so that both extend and retract together (eg, as described below), for example, the two arms are gears with a fixed center of rotation (eg, racks). -It has an extension element engaged on the opposite side of the pinion mechanism).

  In an exemplary embodiment of the invention, other devices are used to provide mirror image motion. For example, in an application using standard equipment, mirror motion is provided by the user holding the mouse in one hand (or continuing with the same hand) and moving the movement from one hand to the other. Is done. In another embodiment, one or two force feedback joysticks are used. It should be noted that multiple devices may be used for some embodiments including this. In particular, relatively simple and / or standard hardware (eg, force feedback joystick or touch display) can be used for specific applications.

[Combined motion]
FIG. 9A illustrates a two-part rehabilitation instrument 900, a first portion 902 associated with wrist movement and a second portion 904 associated with elbow movement. As described below, the portions 902 and 904 can be ball-type devices. In addition, an optionally adjustable connecting portion 910 fixes the relative positions of the portions 902 and 904. A connecting portion 912 optionally connects the wrist holder 906 and the elbow holder 908 to each other. Device 900 is used to provide exemplary control of multiple points on a limb (eg, arm or leg) during rehabilitation.

  In use, each of the holders 908 and 906 can also control three spatial dimensions and optionally angular dimensions, thus allowing more complex movements to test, train and / or provide. . Optionally, the possibility of restricting constant movement (eg preventing constant rotation of the joint) is beneficial from a safety standpoint. Optionally, the points are controlled with 3, 4, 5, or 6 degrees of freedom of motion. Optionally, the control in some of the degrees of freedom is different than in other degrees of freedom. For example, movement in one axis may have resistance associated with that movement, while angular movement may result in assistance assisted while providing some force by the device 900.

  It should be noted that in apparatus 900, the trajectory is defined as a relative trajectory. In the relative trajectory, the actual position of the device 900 is not as important as the relative position or spatial movement of the holders 906 and 908.

  FIG. 9B illustrates a rehabilitation device 920 that includes a portion 928 having an arm 932 with an arm holder 930 mounted thereon. The holder 930 restrains both the elbow using the elbow holder 924 and the wrist using the wrist holder 922. The optional rotation mechanism 940 rotates the holder 930 around the arm 932 while the optional rotation mechanism 926 rotates the holder 930 perpendicular to the arm 932. Alternatively or additionally, a similar mechanism (not shown) is optionally provided to rotate the holder 930 about its axis.

  As described below, another type of combined motion supported by a rehabilitation device according to an exemplary embodiment of the present invention requires synchronized motion of several body parts (eg, arms and legs).

[Ball device]
As described above, designs other than articulated arms can be used for the device 100. In particular, in an exemplary embodiment of the invention, the device is based on a universal joint from which an arm extends and the arm optionally varies in length.

  In an exemplary embodiment of the invention, the universal joint is used as a ball-in-socket joint. FIG. 10 shows an exemplary rehabilitation instrument 1000 using a ball joint. This reference sign is used in a general sense for some ball-type devices as described herein.

  The apparatus 1000 includes a base 1004 (for example, a table including a plate 1016). The plate has an opening 1017 that is contoured therein, and the opening surrounds the ball 1010. Ball 1010 is optionally placed on a plurality of rollers. In the alternative embodiment shown in FIG. 11, the roller 1012 is replaced by a bottom plate 1015 (which contours an opening 1013 that supports the ball 1010 therein).

  The arm 1002 extends from the ball 1010 and is optionally counterbalanced by a counterweight 1018 attached to the opposite side of the ball 1010 with a rod 1022. The rod 1022 optionally passes through a slot opened in an optional guide plate 1020 (detailed below).

  In use, the ball 1010 rotates to allow the tip 1008 of the arm 1002 to define various trajectories in space. Optionally, arm 1002 is extendable so that the volume of space can be filled with a trajectory. Optionally, arm 1002 includes a motor or brake 1024 (eg, a hydraulic brake) to automatically move or otherwise resist the extension.

  In an exemplary embodiment of the invention, a brake 1014 is provided for the ball 1010. One potential advantage of using a relatively large ball 1010 is that torque at the ball surface (eg, the torque required to brake or move the arm 1002) is required for small joints. It allows the use of motors or other machine elements that are generally smaller than those that are likely, perhaps smaller or cheaper. Alternatively or additionally, the position control of such a motor and / or the detection sensitivity of the position sensor can be made smaller while still allowing sufficiently precise control and feedback.

  The device 1000 can be provided in various configurations. In the simplest arrangement, the device is completely passive and the user can simply set the plate setting (described below) and the resistance setting to the brake. In more advanced configurations, the resistance can be changed in real time by computer control. In another advanced arrangement, a ball and / or arm position detection function is provided (eg, using a sensor not shown). In another advanced arrangement, the directional resistance can be varied (eg, using a directional brake not shown). In another advanced arrangement, the driving force (optionally directional) can be set or changed using, for example, a plate and / or multiple directional motors (which can also be used to provide resistance).

  In an exemplary embodiment of the invention, multiple motors are used to control the movement and / or force of arm 1002. In order to determine the arm position, the motor optionally has an optical position encoder. Alternatively or additionally, stepping motors or servo motors are used. Alternatively or additionally, non-contact sensors (eg, reading optical marks from ball 1010) are used. In the exemplary embodiment of the invention, roller 1012 is replaced by a motor that rotates the wheel. If one wheel is in a direction perpendicular to the other wheel (relative to the surface of ball 1010), then selective movement in one or both directions (eg, if the movement perpendicular to the wheel is a low friction sliding) Can be realized. Only one roller is replaced by a motor with a rotating wheel. The wheel is oriented in the desired direction of motion and rotates to achieve the motion. Directional resistance is optionally realized using a motor. Alternatively, the resistance is realized by a combination of motors that apply force or resistance, and the general resistance is applied by the brake 1014. Optionally, one or more strain sensors are provided or integrated with the motor to determine the direction of the force applied to arm 1002. The motor can respond to opposing, assisting, or deflecting forces as needed.

  In the exemplary embodiment of the invention, the brake 1014 operates by raising and lowering the brake toward the equator of the ball 1010. At this time, the inner diameter of the brake is smaller than that of the ball. Alternatively, the brake expands and contracts as needed. Alternatively or additionally, the outer perimeter of the brake is modified, for example, formed from a shape memory alloy that, when heated, causes an instantaneous expansion and / or contraction of the brake. Alternatively or additionally, a vertical brake is used that is pressed against the surface of the ball 1010 towards its center.

  Alternatively or additionally, directional brakes can be used instead of or in addition to unidirectional brakes. For example, a blade-like rubber pad that has a relatively low resistance that allows movement perpendicular to the blade and resists movement of the ball along the blade by deflection.

  If the arm 1002 is extensible, the force applied to the point 1008 also includes a component generally along the axis of the arm 1002 to which the brake or motor 1024 can respond, optionally in the responsiveness of the ball 1010. It should be noted that this is taken into account.

[Balance]
FIG. 11 illustrates the balancing of the apparatus 1000 according to an exemplary embodiment of the present invention. As described above, FIG. 11 shows a variation of the device 1000 where the ball 1010 is supported by a plate 1015. The weight 1018 is optionally designed to accurately cancel the moment of the arm 1002. Alternatively, add or remove a modular weight, for example, by changing the distance from the ball 1010 to provide a force to return the arm 1002 to a rest position or to force it away from the rest position. The weight is designed or modified. In some cases, the balance is adjusted to match the weight of the attachment or patient's limb.

  Optionally, when arm 1002 is extendable, the extension includes a moving counterweight that extends outward from the center of ball 1010 so as to maintain the center of gravity of ball 1010. This movement may only be inside the ball.

  Alternatively or additionally, balancing of the ball 1010 is provided by automatic balancing by a motor and / or brake. The automatic balancing can be used to effectively reduce or cancel the moment of inertia of the ball 1010 and arm 1002.

  If the attachment is attached to the tip 1008, this may change the balance. Optionally, for each such adjustment, a suitable weight is provided for addition to the balancing weight 1018. Alternatively, the handle 1008 has one or more contacts or circuits that are compatible with the one or more contacts or circuits in the attachment fit. This allows the device 1000 to sense which attachment has been added and move the weight 1018 appropriately to compensate. An appropriate table is optionally downloaded from the remote site. Alternatively, the attachment includes a pile of appropriate length that moves the arm balancing weight inside the ball 1010 by pushing it into the tip 1008. The movement of the weight 1018 may optionally be moved by a motor (not shown), for example along the connecting rod 1022 and / or away from the straight line connecting the rod 1022 and the arm 1002. Alternatively or additionally, device 1000 self adjusts by sensing applied torque moment and moving weight 1018 to compensate for it.

  Optionally, the balance is designed for the expected weight or force applied by the person during the activity.

  FIG. 11 also shows the rod 1022 constrained to move in a straight line by a slot 1030 in the plate 1020.

[Guide plate]
In general, computer controlled directional motors and brakes can achieve any desired motion, and in some embodiments of the present invention, perhaps more limited motion is applied to the plate 1020 and its associated slot. Supported by the use of. A potential advantage of using a guide plate is that movement perpendicular to the slot is usually not possible, and this eliminates the need for proper circuitry.

  FIG. 12 illustrates a drive train for a plate rehabilitation device according to an exemplary embodiment of the present invention. A first optional motor 1046 is attached to a gear 1048 that rotates the plate 1020 to allow movement of the rod 1022 other than a straight line. The second optional motor 1040 is attached to a threaded rod 1042 on which the rod coupler 1044 moves. As the coupler 1044 moves, the coupler moves (or resists) the rod 1022 along the slot 1030. Other mechanisms can also be used.

  As illustrated in FIGS. 3A and 3B, it may be desirable to provide a change rather than full resistance to movement perpendicular to the slot 1030. FIG. 13A illustrates an exemplary coupling device 1300 to replace the coupler 1044 having this characteristic. The coupling device 1300 includes a body 1314 having an internal thread portion 1302 for mounting on the threaded rod 1042. The body 1314 further comprises an opening element 1306 having an opening 1304 that engages the rod 1022. One or more spring elements 1308 couple the element 1304 to the body 1314. Optionally, the tension of the spring element 1308 can be adjusted, for example, by a screw 1310. Optionally, a linear displacement sensor 1312 is provided to measure an error in the position of the rod 1022. Element 1308 is provided in the direction of slot 1030 and / or in a direction perpendicular thereto. Other exemplary force control mechanisms are illustrated in FIGS.

  FIG. 13B shows an elastic guide 1340 formed from two halves 1342 and 1344 connected by one or more springs 1352 and 1354. Thus, the slot 1346 formed between the two half edges 1348 and 1350 has some elastic conformability. Alternatively or additionally, edges 1348 and 1350 are at least partially resilient (eg, made of rubber).

  FIG. 14A illustrates another apparatus in which two guide plates, an upper guide plate 1020 and a lower guide plate 1402, are used in tandem. Optionally, a separate motor is provided to rotate each guide plate.

  FIG. 14B illustrates a guide plate having several slots. The filled area is provided so that the cutout does not fall out. Alternatively, other methods (eg, out-of-plane cross-linking) can be used.

  FIG. 14C shows a guide plate having an “X” shaped slot. For example, other shapes such as a circle with a cross inside and a bent slot can be given.

  In an exemplary embodiment of the invention, programming of device 1000 also includes slot replacement and / or resistance setting. Optionally, once the slot is inserted, the device 1000 may use it, for example using a contact sensing mechanism as described above, or using wireless or RF communications (eg by embedding a smart card circuit in the plate). Recognize

[Accessories and restoration attachment]
FIG. 15A illustrates a restore attachment 1500 according to an exemplary embodiment of the present invention that provides control and / or feedback for one or more hand movements.

  It is assumed that the forearm rests on the rest 1510 when the grip 1502 is held by hand. The grip 1502 is gimbaled on one or more axes relative to the rest 1510. In the illustrated example, the handle 1502 is attached to a base 1503 that includes a rod 1504. Joint portion 1506 can optionally rotate about and / or move along the axis of rod 1504. In addition, an optional rod 1508 interconnects the rest 1510 and the joint 1506 to allow rotation about the rod 1508. Further, the optional rod 1512 contacts the joint 1506 in a direction perpendicular to the other two rods, allowing rotation about its third axis.

  Optionally, restore attachment 1500 is attached to tip 1508 at rest 1510 or attached to rod 1508 at base 1514.

  Optionally, one or more of the described relative movements are supported by one or more motors and / or controllable brakes.

  In some restoration attachments (or even for other attachment devices), one or more springs operate the rehabilitation device to provide the variable resistance shown in FIGS. 3A and 3B in one or more dimensions.

  FIG. 15B shows a restore attachment 1520 according to an exemplary embodiment of the present invention, generally in accordance with the configuration of the device 1500. The handle 1522 is gripped by the patient and the patient's arm is placed on the armrest 1524. Optionally, one or more straps (not shown) are provided that are attached through one or more strap holes 1526. Base 1542 provides a connection with arm 102 (not shown, but illustrated in FIG. 15C) by connector 1528. In an exemplary embodiment of the invention, for example, a universal connector is used that is compatible with the numerous attachments described herein. In an exemplary embodiment of the invention, the connector provides one or more of mechanical fixation, power (eg, power) and data transfer. Optionally, the connector also provides the device 100 with attachment identification information.

  In the illustrated embodiment, mechanical wrists 1530, 1532, and 1534 support three wrist rotational movements. Optionally, one or more resistances of the joint are adjustable. In the illustrated embodiment, the adjustment is a manual adjustment (eg, using one or more of knobs 1536, 1538, and 1540). Alternatively, internal adjustment is provided, for example using a small motor. The resistance can be, for example, a friction type or an elastic (eg, spring) type. Optionally, a rotation sensor (eg, an electrometer) is provided for each joint.

  Optionally, the handle 1522 is replaceable, for example, the pull pin 1544 can be used to selectively unlock and remove the handle 1522.

  FIG. 15C shows another variant of the restore attachment 1550 from the opposite side, similar to the restore attachment 1520 (eg, the knob 1552 is in a different location from the knob 1538). Also shown is the mounting of a restore attachment on the arm 102. In an exemplary embodiment of the invention, the implementation includes a ball joint (optionally with a frictional resistance function). Optionally, the socket joint is designed to disconnect when subjected to a torque above a certain level, for example as a safety feature. Optionally, this safety level is configurable. In an exemplary embodiment of the invention, the joint consists of balls held between two plates that are interconnected by a spring with a configurable resistance. Wires are optionally provided to interconnect the plates, and a signal is generated by the pitch (eg, of an overextended spring). Optionally, a lifeline is provided so that each part of the joint does not fall apart.

  Another variant replaces a single armrest 1524 and illustrates two armrests 1558 and 1556. Optionally, a strap is provided only on the distal armrest (1558). An optional pad 1560 is also shown.

  FIG. 15D shows a non-vertical handle attachment 1560. Although an angle of 90 degrees is illustrated in the bent portion 1562, another angle (for example, 45 degrees) may be given. Optionally, the angle allows better control of muscle movement and / or facilitates some exercise. Optionally, the flexure 1562 can be adjusted to preset angles such as 0 degrees, 45 degrees, and 90 degrees, for example.

  An optional universal attachment 1564 is shown.

  FIG. 15E shows a grip 1570 with an indentation 1572 for the optional finger shown. An optional button 1574 for patient input is shown. Additional buttons can be provided, and multiple buttons can be provided in other embodiments.

  Optionally, the body 1576 of the handle 1570 can be squeezed (as is the case in other embodiments). One type of squeezable body includes a gas filled bladder. Optionally, the compression of the gas can be changed to change the resistance. In an alternative embodiment, the body 1576 is formed from two panels separated by one or more springs.

  An optional universal attachment 1578 is shown.

  FIG. 15F shows a two-handle embodiment 1580 that includes two handles 1582 and 1586 (optionally changeable by pins 1584 and 1588). This embodiment is useful, for example, when one hand is required to assist in the movement of the other hand. The two handles actually used need not be identical.

  An optional universal connector 1590 is shown.

  Other attachments can also be used. In one example, a cup-shaped attachment is used. The patient can hold the cup as a glass or by the act of picking its handle. Various sensors are provided for measuring the picking and / or grasping force (as applied to the glass). Alternatively, known attachments can be used, optionally modified to include universal connectors and / or appropriate sensors. Optionally, an attachment with a strap for binding hands is provided.

  Optionally, the attachment used imparts sensation to the patient (eg, vibrates, stabs, tightens the surface tissue). To cause and control such a sense, the attachment can be supplied with power as well as data. The surface texture can be varied, for example, by providing a smooth layer with an uneven underlay. By stretching the unevenness or the uneven layer, the surface texture changes.

  Although attachments have been described for the arms, it should be appreciated that such attachments can be provided to other limbs and also to the head and neck. In one example, the pedal is provided as a restoration attachment for the foot. Various rotations of the restoration attachment can also be provided for the foot. Similarly, the head and neck attachment can be designed to maintain support for various rotations and / or movements of the chin relative to the neck.

  Another type of attachment is not directly attached to arm 102 (eg, patch 504 in FIG. 5).

[Elbow Support (Elbow Support)]
FIGS. 16A through 16D illustrate various methods of elbow support according to an exemplary embodiment of the present invention. As noted above, it is beneficial for some rehabilitation methods to provide support and / or suppression of elbow (or other body part) movement. In an exemplary embodiment of the invention, device 100 supports the weight of the limb so that the patient can focus on moving the limb rather than holding the limb in space. Conversely, the device 100 is configured to prevent the patient from leaning against the device, for example by the device 100 that accurately provides the force expected to be applied by the limb (optionally, with some allowance). can do. Optionally, the degree of force varies along the trajectory (eg, when stretching the limb).

  FIG. 16A shows an elbow support 1604 attached by wire to a frame 1602 secured to a rehabilitation instrument. Optionally, frame 1602 can be folded. Optionally, the frame 1602 is designed to allow wheelchair entry so that the patient in the wheelchair does not need to leave the chair for rehabilitation. One or more foot pedals 1609 are provided for foot training and / or other rehabilitation activities. Optionally, a pedal is used to support coordinated exercise training of arms and legs. Similar to the various centers described in this application, a pedal can be provided that moves in multiple degrees of freedom. A vertical motion mechanism 1606 is shown that provides space for a patient's knee sitting in a wheelchair.

  In the simplest embodiment, a wire 1605 (eg, its length) is placed at the desired elbow position. Optionally, three wires are used to secure the elbow support 1604 in space. Optionally, more wires (eg, 4 wires) are provided to prevent support 1604 from moving when not in use. While the wire is used to position the elbow support, it can also be used to support other body parts. Optionally, multiple sets of wires are provided to support multiple body parts. Optionally, a wire system is used in place of arm 102 or 1002 to control the position of the tip (or attachment) or point on the body.

  In an exemplary embodiment of the invention, the wire system is used for spatial position measurement. In one example, wire 1605 is retracted and attached to a measuring device such as an encoder. Interpolation can be used to give the support 1604 XYZ coordinates. In another example, as described above, the wire is used to measure the relative position of the chair and the rehabilitation device (eg, frame 1602).

  Optionally, a wire mechanism is attached between the two limbs and used to measure their relative distance. Multiple wires can be used to measure more than just distance.

  Optionally, the wire system can be used to measure additional parameters such as force applied to the limb (optionally including direction) and speed of movement. It should be noted that a coupling system can be provided that includes both robotic and wire elements (relative to the same point or tip 108).

  In an exemplary embodiment of the invention, the wire system is controlled using, for example, a motor to maintain constant tension. Optionally, use of this allows for limb floating support. Optionally, the motor is used for motion control or assistance. For example, a motor is used to shorten the wire or to allow the wire to be paid out at a constant speed or when a constant force is detected.

  Optionally, wire 1605 provides flexibility against tension, for example by including a spring attached to wire 1605 (eg, at point 1608 that also includes a motor). Optionally, the tension of the spring can be changed, for example using an electric motor. Optionally, a spring is generally used to provide cushioning.

  FIG. 16B shows an elbow support 1604 supported by an arm 1610 extending from the rehabilitation instrument. Optionally, arm 1610 includes a linear extension measurement element and two rotational measurement elements to indicate the position of support 1604. Other embodiments described herein can also include such sensors so that the device 100 can calculate the position. A force sensor may also be provided as described above to assist in analyzing the force applied to the support 1604 by the patient.

  FIG. 16C shows an elbow support 1604 supported by a joint arm 1620 extending from the rehabilitation instrument.

  FIG. 16D shows an elbow support 1604 supported by a member 1630 protruding (and / or attached) from the arm 1002.

  Optionally, the extension arm and member are configurable. Alternatively or additionally, the arm includes a motor and / or a variable resistance element. Alternatively or additionally, the arms and couplers include position, orientation, displacement, and / or force sensors. In an exemplary embodiment of the invention, the actual position of the various portions of the arm can be determined based on the fact that one or more portions of the arm are fixed and known in length. Whatever joint is provided, the angle of the joint is determined.

  An example of an additional elbow support built into the docking station is shown in FIG.

[Change orientation]
In some embodiments of the invention, it is desirable for the arm 102 to have a non-vertical central rest position. FIG. 17A shows a rehabilitation instrument 1700 comprising a joint 1702 between its base 1704 and its motion mechanism 1706 that can take multiple orientations.

  Alternatively, one of the rehabilitation instruments described above can be placed on a surface other than the floor or on a leg with an irregular length. Optionally, when the device 1000 is installed on the wall or upside down, a roller such as a roller 1012 is also provided on the ball 1010 so that the ball 1010 can be supported regardless of the orientation in which the device 1000 is installed. It is done. Installation is realized, for example, with screws or using an adhesive.

  One potential advantage of a rehabilitation device that changes orientation is the ability to rehabilitate the patient while changing position. For example, some training (for example, reaching training and balance training) is effectively performed when standing. Some training must be performed while lying if the patient is bedridden. Some exercises are performed while sitting, while others are performed with the knees on.

  Another potential advantage is the ability to rehabilitate different body parts with the same device using the same system.

  Another potential advantage of reorientation devices that change orientation is that many arm movement mechanisms have limited range of motion, coupling between axes, and / or other mechanical considerations. Changing the orientation of the device allows the motion mechanism to be placed in a more optimal position. It should be noted that in some reorientation devices, the controlled tip 108 remains in the same position even if the motion mechanism moves. This allows, for example, a patient to remain in a wheelchair during a training change.

  Although manual orientation changes are shown, one or more motors can be used to achieve the orientation change. By providing one or more angle sensors, the actual rotation of the joint 1702 can be detected (in one or two directions).

  17B and 17C show an alternative variable orientation rehabilitation instrument 1710 that changes two orientations. In FIG. 17B, an angled orientation is shown, and the support plate 1724 aligns the motion mechanism 1720 and arm 1722 with respect to the base 1712. Optionally, one or more extensible legs 1714 are provided for stability. An optional wheelchair guide 1716 (optionally extendable) is provided. Optionally, the guide 1716 is grooved to allow the wheel to enter therein. Optionally, chucks are added on both sides of the wheel to lock the wheel in place. An optional bracket-type locking mechanism is not shown in which one or more pins or brackets engage the wheel from one or both sides of the wheel, eg, along the axle. Such a mechanism can be actuated by the patient himself, for example electrically. This wheelchair locking mechanism can also be used in other embodiments of the present invention.

  In an exemplary embodiment of the invention, the flat plate 1724 can be arranged at various angles. FIG. 17B shows an angle of about 45 degrees. FIG. 17C shows an angle of 90 degrees. Also shown in FIG. 17C is a second support plate 1726 attached by a hinge 1728 that can be locked to the support plate 1724. In FIG. 17B, the flat plate 1726 is flat with respect to the base 1712. An additional possible mode is an angle of 0 degrees, where the plates 1724 and 1726 lie flat in the recess 1734 of the base 1712. The hinge 1730 is used to rotate the motion mechanism 1720 so that the motion mechanism points upward. Optionally, motion mechanism 1720 is coupled to hinge 1730 via a rotatable base 1721. Another exemplary arrangement is where the flat plate 1724 lies within the recess 1732 such that the rotatable base 1721 also lies within the recess 1732. This is a transport mode in which the arm 1722 is removed and the entire device 1710 can be stored, for example, in a car trunk. Slab 1726 is optionally attached to base 1712 by another lockable hinge (not shown).

  FIG. 17D shows an alternative rehabilitation device 1740 in which the position of the motion mechanism 1748 can be adjusted. In this embodiment, rail 1744 extends from base 1742 and motion mechanism 1748 is coupled to a moving body 1746 that rides on rail 1744. Optionally, to more effectively utilize the range of motion of mechanism 1748, motion mechanism 1748 is attached to mobile 1746 by a hinge (eg, using mobile 1746 rather than using mechanism 1748 to move Allowing the center of arm 1750 of device 1740 to be centered in space).

  Rail 1744 is optionally folded for movement. Rail 1744 optionally has a built-in data bus and power bus to transmit at least power to mechanism 1748. Alternatively, a flexible cable (not shown) is used. Base 1742 (similar to other bases disclosed herein) may optionally include wheels.

[Multi-limb device]
In an exemplary embodiment of the invention, multiple limbs can be trained together, for example, to rehabilitate synchronous movement. In an exemplary embodiment of the invention, a plurality of modules as may be used in the apparatus 1000 are attached in various configurations to achieve this effect. The attachment is, for example, structural (eg, suppresses undesired relative motion but is probably adjustable), mechanical (eg, transfers motion from one module to another), and And / or can be controlled (e.g., modifying an interaction in one module in response to or synchronized with an interaction in another module).

  FIG. 18 shows a rehabilitation instrument 1800 for arms and legs, according to an illustrative embodiment of the invention. Device 1800 includes a first portion 1804 for training the arm (eg, using device 1000) and a second portion 1802 for training the leg (eg, also using the mechanism of device 1000). Including.

  One exemplary use of this type of device is to rehabilitate hemiplegic stroke patients. Another exemplary use is to train synchronous exercise, such as is required for walking.

  In some cases, two side-by-side rehabilitation is desirable. FIG. 19A shows a rehabilitation instrument 1900 with four mechanism modules. A set of modules 1902 and 1904 are used to control the movement of the right arm, and a set of mechanism modules 1906 and 1908 are used to control the movement of the left arm. The two sets of modules can be synchronized and / or used for instruction, for example, as described above.

  Optionally, one or more modules are added to train each leg. In the illustrated example, one or more pedals 1910 are provided, such as in FIG. 16A. However, as mentioned above, devices with more degrees of freedom can be used. Optionally, for example, US Provisional Patent Application No. 60 / 633,428, filed Dec. 7, 2004 (the same filing date as the present application, the same applicant filed a PCT application (titled “Method and Apparatus for Walking Rehabilitation”). ”, Agent case number 414/04391), the disclosure of which is incorporated herein by reference). Optionally, such a mechanism attaches to the ankle and rotates and / or translates the ankle (eg, foot) in various (eg, 2, 3, 4 or more) directions to rehabilitate walking. Including support that can. Optionally, one or more mechanism modules are provided for training hip exercise while sitting. Optionally, a treadmill or training bike is provided for the patient to walk while training the upper body. The treadmill movement is optionally synchronized to rehabilitation training and actual patient movement. Optionally, gait training consists of training various body parts separately and together for a complete (or partial) gait.

  Optionally, device 1900 is used with a wheelchair rather than a normal chair.

[Docking system]
FIG. 19B shows a docking station 1920 and FIG. 19C shows a docking station 1920 containing a wheelchair 1922. By docking station is meant a structure into which a patient is transported, locked in place and undergoes rehabilitation. From a functional point of view, it is generally desirable to require minimal patient manipulation to begin the rehabilitation task. Thus, for example, the patient can remain in a wheelchair, and instead of optionally adjusting the patient's position (eg during the first and training changes) to ensure correct relative positioning The rehabilitation device moves spontaneously by selection.

  In the illustrated embodiment, two variable orientation modules 1924 and 1926 are provided on track 1928. Optionally, the module is moved by hand. Alternatively, a motor (not shown) changes the configuration of the module and / or moves the module along track 1928. Track 1928 optionally provides power and / or data to the module. An orientation-invariant module or other rehabilitation device can also be attached.

  An optional wheelchair locking mechanism 1932 disposed on the track 1930 is illustrated. Optionally, the position is changed manually. Alternatively, the position is changed using a motor (not shown). Similarly, the wheelchair engagement mechanism can be manual or motorized.

  Although a foot pedal 1934 is shown, it can be replaced with other foot training devices.

  An optional elbow support 1936 attached to the joint 1938 is shown. Optionally, the elbow support 1936 is suspended in the air with respect to the patient, optionally by offsetting the person's weight. Optionally, the float is in a plane, for example in a plane parallel to the floor. Optionally, the elbow position is measured by the support and can be used for various feedback, such as measurement of motion characteristics. For example, as illustrated in FIG. 16, a support 1936 is optionally placed over the telescope mechanism and / or the articulated arm mechanism.

  A display 1940 is optionally provided, eg, for use by the therapist and / or patient. In addition, an input system 1942 (eg, a keyboard or joystick) may be provided. Optionally, the input and output devices 1940 and 1942 can be rotated into a different configuration for access by the therapist when the docking station 1920 contains the patient.

  Display 1940, input 1942, and / or joint 1938 are optionally placed on a pillar (optionally a telescoping pillar). Optionally, a patient-specific (visual and / or auditory) display 1946 is provided.

  A similar docking station is provided for the moving bed, for example with four motion mechanisms for each limb. Alternatively, as described below, the device is made sufficiently portable so that it can be brought to a bedridden patient.

[Mobility]
A feature of some embodiments of the invention is that a movable rehabilitation device is provided. There are various levels of mobility, and as described herein, various embodiments of the present invention can achieve these levels.

  In an exemplary embodiment of the invention, the mobility of the rehabilitation device is used to move the device within or between wards.

  FIG. 19D shows a mobile rehabilitation device 1950 positioned near a bed 1951 according to an exemplary embodiment of the present invention. In this embodiment of the mobile device, the motion mechanism 1952 is installed on a rail 1958 (eg, a curved rail with a base 1960). Wheels, optionally lockable and / or extendable legs (not shown) may also be provided on the base 1960. To adjust the position of the mechanism 1952, the rail 1958 optionally has one or more tracks 1962 (elongated grooves shown). Two different attachments are shown (arm 1954 and leg 1956). Optionally, wheels are used to move device 1950 into the hangar. The folding device is the one described above, for example, FIG. 17B.

  FIG. 19E illustrates an alternative mobile rehabilitation device 1964 coupled to a bed 1951 according to an exemplary embodiment of the present invention. One or more attachment mechanisms 1972 lock the device 1964 to the bed 1951. Optionally equipped with wheels. The device 1952 can be used for rehabilitation from above, for example. In an exemplary embodiment of the invention, the device 1964 includes a frame 1970 on which the motion mechanism 1952 is mounted at the top 1966. Optionally, device 1952 is movable along the frame. A ball grip attachment 1968 is illustrated.

  Mobility can also be useful in other surrounding environments (e.g., homes or small clinics). In addition, as described above, the active rehabilitation device is brought in by a therapist who performs a home treatment.

  In an exemplary embodiment of the invention, the rehabilitation is performed in water (or in a steam bath), i.e. by supporting the patient with water and / or providing heat and / or massage. FIG. 19F illustrates the use of a mobile rehabilitation device 1972 in a bathtub 1976 according to an exemplary embodiment of the present invention. Although a wheeled base 1978 is illustrated, other types of bases can be used including a fixed base. In the illustrated embodiment, two arm attachments 1974 with extended connections are used, and the patient may sit or lie down.

  Rehabilitation can also be performed in a swimming pool, for example, by a device 1972 attached to the ceiling of the pool.

  In an exemplary embodiment of the invention, the rehabilitation device is kept out of the water, but the attachment is waterproof. Optionally, the device itself is waterproof or at least waterproof. Optionally, to prevent the risk of electric shock, the rehabilitation device is battery powered. Alternatively, a pneumatic or hydraulic / hydraulic motor is used instead of an electric motor. Optionally, a low voltage (eg, 24, 12, 5 volts or less) is used to power the rehabilitation device. Optionally, a device with a brake and no motor is used.

  In an exemplary embodiment of the invention, the mobility of the rehabilitation device is utilized for rehabilitation in the outdoors (eg, in a human garden (eg, on grass) or in nature). In one example, the rehabilitation device is used for recreational activities such as barbecue. The device assists in guiding, diagnosing, and training (eg, flipping a hamburger steak) a patient. Optionally, large wheels are provided to move more lightly over soft ground. In another example, a rehabilitation device is used to rehabilitate outdoor activities such as golf and fishing. Optionally, special attachments are provided for such activities in order to adapt the range of motion of the motion mechanism used to such activities. In the fishing example, the rehabilitation device helps, for example, hold a fishing rod, throw a bristle while providing a range of motion for the shoulder, and counter the fish pull (the force changes). Exemplary attachments are an attachment to a fishing rod and an attachment to the tip of the rod (eg, simulating a fish).

  In an exemplary embodiment of the invention, a leveling mechanism is provided for the uneven surface. For example, this mechanism, similar to that of FIG. 17A, includes a tilt sensor that detects a horizontal plane and adjusts the motion mechanism to an appropriate arrangement.

  In an exemplary embodiment of the invention, a tip and / or tilt detection mechanism is provided. Optionally, when a tip is detected (eg, acceleration at the base of a rehabilitation unit), the unit generates an alarm signal. Optionally, any attachment attached to the patient is opened to prevent damage to the patient. Optionally, when the tip is detected, the base has a foldable portion so that the base can fold one part and allow the device to be separated from the patient.

  In an exemplary embodiment of the invention, a mobile rehabilitation system for use outside a sterile environment is easy to clean and / or easily withstands spills, dust and some weather conditions. It is made like so. Optionally, the electronic instrument and motion mechanism are sealed. Optionally, the joint is covered with a flexible rubber to reduce the irregularities. Optionally, an easy to wipe plastic coating is provided on the device.

  In an exemplary embodiment of the invention, the rehabilitation system is mounted on a wheelchair (eg, to the side or back) or in a car (eg, in a seat near the driver). Optionally, the device can be stowed behind a light van, which is a mobile rehabilitation unit that can be trained by a person (possibly in a wheelchair, perhaps using a lift). Configured to be used as

[Module method]
In an exemplary embodiment of the invention, the rehabilitation device optionally features a modular design. Such a modular design embodies one or more of the following ways.

  (A) The device can be disassembled into modules. This allows maintenance, for example, by replacing defective modules. Alternatively or additionally, being able to be disassembled into parts that can be quickly assembled again by an amateur reinforces the mobility of the device. In an exemplary embodiment of the invention, no special tools are required to disassemble or assemble the device. Optionally, a simple screw driver or rotating spanner is used. Optionally, the device can be disassembled / folded or replaced within one hour. Optionally, the time required is, for example, less than 30 minutes, less than 20 minutes, or less than 10 minutes, 5 minutes, 2 minutes.

  (B) The device itself is one module. For example, as seen in FIG. 19, the same motion mechanism module can be used for multiple different rehabilitation configurations. Optionally, the unit as illustrated in FIG. 17 is used as an attachable / detachable module for the docking station of FIG. 19B.

  (C) Modular attachment. For example, as illustrated in FIGS. 16-19, the usage can be changed by adding various types of attachments to the same basic device. In a particular example, the device adapts to the size of various patients (eg, children with cerebral palsy) by exchanging parts (eg, arms 102) with appropriately sized parts.

  In some embodiments of the invention, the hand attachment includes mechanical and electrical quick connections. The mechanical quick connection includes a pin that fits into the hole while locking an electrical quick connection with a spring-loaded needle on one side and a surface pad on the opposite side. The same connector set can be used for multiple attachments.

  (D) Modular software. Optionally, it is provided as modular software used by the rehabilitation device. For example, with separate modules for different attachments, modules with multiple sets of training, separate modules for different modes of exercise, and / or separate modules for different uses of the device (eg, group, home, clinic), etc. is there.

[Everyday life]
As described above, in an exemplary embodiment of the present invention, the rehabilitation device may be, for example, opening a door, eating at a table, reading a book, dressing, brushing teeth, brushing a face. It is used to help rehabilitate patients so that daily activities such as washing can be realized.

  FIG. 19G shows a rehabilitation device 1980 adapted and configured for use for daily activities, according to an illustrative embodiment of the invention. The rehabilitation module 1952 is mounted upside down on a table 1986 set with various dishes. Elbowrest 1984 is optionally provided. A frame 1988 that supports the mechanism 1952 is attached to the table 1986 of this embodiment. Alternatively, the frame 1988 is wide enough to enclose an existing table or other household element.

  In use, the patient's hand is strapped to the movable tip 1982 of the device 1980 and the user is tried or guided through routine activities such as picking up the fork. Optionally, gloves with force feedback are used to selectively rehabilitate individual fingers. Such gloves are known in the art.

  In an exemplary embodiment of the invention, one or more for the patient to perform the activity while testing the patient's current ability to perform activities related to daily life and / or monitoring the patient's capabilities The device 1980 is used to train The test and / or monitoring is used by the insurance company to determine the necessary compensation or assistance. The test is repeated over a period of time to detect fraudulent activity due to a sudden increase in ability.

  It is noted that quality of life is a very important goal of rehabilitation. This problem is addressed and determined by training and testing the ability to optionally perform various daily activities.

  In an exemplary embodiment of the invention, a separate attachment is provided for daily activity training. In one example, a spill indication cup with a tilt sensor is provided. In another example, a whiteboard with the ability to detect pen position is used in rehabilitation training to write on the wall. The detected position and / or pressure is reported to a rehabilitation device that optionally grasps, supports and / or guides the patient's hand.

  In an exemplary embodiment of the invention, providing one or more patches (e.g., a sticker with sensors such as position sensors and pressure sensors) and affixing the patches to everyday life items (such as hammers and walls) Depending on the situation, daily necessities change into attachments. The rehabilitation device includes, for example, a position determination means such as a wireless unit that communicates with a position sensor on the patch and a camera that captures the patch so that the rehabilitation device can determine the relative position and / or orientation of everyday items. In some optional preparations, rehabilitation and / or diagnosis is performed using the methods described herein, but without mechanical instructions or kinesthetic feedback. Optionally, vibration or other feedback is provided to the patient by applying a vibrating patch (under the control of the rehabilitation device) to the limb being rehabilitated.

  US Provisional Patent Application No. 60 / 566,079 filed on April 29, 2004 (also PCT application by the same applicant as the present application (title “Fine Motion Control Rehabilitation”, Agent Case No. 414/04401) (The disclosures of both applications are incorporated herein by reference) and describe various structures useful for rehabilitation of fine motion control or the linkage of fine and coarse motion control.

  FIG. 19H shows an apparatus 1990 for assisting in training daily activities, according to an illustrative embodiment of the invention. The device 1990 includes two configurable points 1992 and 1993 connected to the base 1994 rather than providing the entire table. A pair of adjustable arms (eg, gooseneck arm 1996) can be used to adjust its spatial position. In use, set points 1992 and 1993 are arranged to simulate the situation, for example to fill tea. In exemplary training, the patient is asked to move the cup from point 1992 to point 1993 (eg, with the aid of a rehabilitation device not shown). At that time, the trajectory is evaluated. Set point 1993 is illustrated as a plane on which an article can be placed. Other structures and attachments (such as hooks) can also be used. Optionally, setpoints 1992 and 1993 (which may be more provided) comprise sensors such as proximity sensors (detecting humans or rehabilitation robots), contact sensors, and / or pressure sensors, for example. The set point can also provide feedback (eg, light, sound, or vibration).

  For example, a position sensor or camera can be used to determine the relative positions of points 1992 and 1993. Alternatively, by touching points 1992 and 1993 in turn with the tip 108, the tip 108 can be used to register their position in the rehabilitation device. In order to calculate the predicted relative position of the tip 108 and the set point when the set point is actually touched by the user's site (eg, a finger, etc.), the arm model is optionally rehabilitation device Mounted on.

[Small chuck]
In an exemplary embodiment of the invention, the joint of the articulated arm is configured to provide selective and / or directional resistance.

  FIG. 20 is a cross-sectional view of such a joint between rod 2004 and rod 2002. Chuck 2006 fits snugly at the trumpet tip 2008 of rod 2004 and engages ball 2012 attached to rod 2002. When the chuck 2006 is retracted toward the rod 2004, the periphery of the ball 2012 is tightened to increase its resistance.

  Optionally, one or more strain sensors and / or optical sensors are provided between the chuck 2006 and the ball 2012 so that the direction of the force applied to the joint 2000 can be determined. Optionally, one or more electrically actuated brake elements (eg, piezoelectric elements that can selectively adjust the degree of resistance) are provided. This can be provided instead of or in addition to the retracting chuck mechanism.

[Balanced gimbal device]
FIG. 21 shows an alternative rehabilitation device 2100 that does not use a ball joint. An optional extendable arm 2102 is optionally balanced about an axis 2106 by an optional counterweight 2110. The counterweight 2110 can also include a motor or variable brake to control the extension of the arm 2102.

  A motor 2108 is optionally provided to rotate the arm 2102 around the axis 2106. A second hinge 2112 is provided to allow rotation about an axis perpendicular to the arm 2102 and the axis 2106. Optionally, the motor 2108 has a weight to balance the arm 2102 with respect to the hinge 2112. Optionally, a slot 2114 is provided in the base 2104 of the device 2100 to function as the plate 1020 and slot 1030 described above. Similar structural arrangements can also be used. Optionally, a rotatable plate 2116 is provided to support the slot 2114. A motor (not shown) is optionally provided for rotation about the joint 2112. Optionally, the position of joint 2112 is raised so that the axis of joint 2112 intersects the axis of axle 2106.

[Alternative gimbal device]
FIG. 22A shows an alternative gimbal device 2200 used as a motion mechanism according to an exemplary embodiment of the present invention. FIG. 22B, which will be described later, shows a device 2200 arrangement with a motor and / or brake.

  Device 2200 has an optionally removable Z-axis element 2204 and a gimbal portion 2202 having an optionally replaceable handle 2206 attached thereto. For example, a modular connector 2208 as shown in FIG. 15 can be used. Optionally, release pin 2210 is used to selectively remove Z-axis element 2204, for example for replacement or storage.

  The gimbal portion 2202 optionally includes a frame 2212 that includes a first hinge 2214. Optionally, guide frame 2216 is attached to a hinge 2214 that provides a first fixed axis and includes a guide passage that guides an extension (or cam follower or pin) 2218 (described below).

  A second fixed axis is also provided by a hinge 2220 on the frame 2212. In an exemplary embodiment of the invention, a handle 2204 is optionally rigidly attached to a frame 2222 that includes an elongate element 2218. Thus, the rotational rotational movement of the handle 2204 is translated into two hinge rotations about the fixed axis. Optionally, elongate element 2218 has a counterweight (not shown).

  FIG. 22B shows the arrangement 2200 employed in the example with two brake mechanisms 2232 and two force control mechanisms 2230 installed. It can be appreciated that an actual device can be configured with only one of resistance and force control. The force control mechanism 2230 will be described in detail later.

  Returning to the brake mechanism 2232, in an exemplary embodiment of the invention, a disk brake mechanism is used in which the disk (or part of the disk) 2240 is selectively restrained by a friction element (not shown). The motor 2250 selectively sets the pressure applied on the disk by the friction element. Other friction mechanisms can also be provided. In the exemplary embodiment of the invention, the following mechanism is used to couple motor 2250 to disk 2240. Coupling 2248 converts the rotational movement of motor 2250 into the axial movement of rod 2247. Optionally, rod 2247 is spring loaded so that no power is transferred to motor 2250, and the pin moves to a locked / unlocked position where friction on disk 2240 is maximized / minimized (depending on the particular implementation). To do. The rest 2246 is therefore selectively lifted or pushed down by the rod 2247. Although not shown, the friction element is coupled to a rotating element that converts rotation of the rotating element into movement of the friction element in a direction toward / separate from the disk 2240. Optionally, element 2242 is a screw. Element 2242 includes a transverse lever 2244 that rotates element 2242 when rest 2246 moves to engage rest 2246. The rotatable element 2242 is optionally spring loaded.

  Other brake mechanisms can be used, such as known brakes (e.g., electric, hydraulic / hydraulic, magnetic, and / or mechanical brakes).

  In an alternative embodiment of the present invention, providing a single unidirectional brake reduces coupling between various axial movements. In the exemplary embodiment of the invention, the brake consists of a spherical portion that is selectively pressed against the pin 2218.

  Also shown in FIG. 22B are various optional sensors. Sensor 2234 is connected to the axis of hinge 2220 and reports when handle 2204 has rotated to its limit. Sensor 2236 reports when the handle is in the reference position (or home position). A sensor 2238 (eg, a rotary potentiometer or encoder) reports the rotation angle of the hinge 2220. Similar sensors can be used for the hinge 2214.

  In some embodiments of the invention, providing safety by stopping the motor, providing programmable resistance (even in systems without automatic movement of the device), and / or balancing (eg, need to cancel external forces) The brake mechanism is used for one or more purposes (by providing friction when there is). Optionally, the braking action in the two modules 2232 is combined to provide a uniform braking action independent of whether the movement of the handle 2204 is along one of the fixed axes.

[Cantilever gimbal mechanism]
FIG. 23 illustrates a cantilevered gimbal mechanism 2300 according to an exemplary embodiment of the present invention. Frame 2302 is coupled to a handle (not shown) that is optionally attachable to drive system 2304 (eg, for selectable extension and resistance to axial movement of the handle) (in FIG. 25). Rigid or not as described). Frame 2302 is rotatably coupled to frame 2306. In the exemplary embodiment of the invention, relative rotation between frames 2302 and 2306 is provided by motor 2316. In the exemplary embodiment of the invention, motor 2316 is coupled to the frame using worm gear 2314 and pinion 2312. Other connection methods can be provided. The worm gear has a lead angle that is small enough to suppress movement of the handle that reverses the motor. Perhaps the worm gear is cheaper, quieter and / or allows the use of a lower cost motor compared to using precision motors and / or gearboxes.

  Using a similar mechanism (only pinion 2308 and worm gear 2310 are shown), frame 2306 is optionally coupled to base bracket 2307.

  Optionally, a brake is provided as described in the previous embodiment.

[Force control mechanism]
FIG. 24A illustrates a force and device control mechanism 2400, according to an illustrative embodiment of the invention. As shown in the figure, the mechanism 2400 includes a drive unit and a force feedback unit. One or both of these parts are not included in some embodiments.

  Initially for the drive, the shaft (not shown) of the hinge 2220 or 2214 is coupled to the inner pinion portion 2402 of the pinion 2404, for example, via a gear portion formed on the shaft. Optionally, other attachment methods, such as direct attachment, are used. The pinion 2404 is rotated by a worm gear 2406 that operates a shaft 2407. In the exemplary embodiment of the invention, power is supplied by motor 2414 via a pair of pulleys 2408 and 2410 connected by belt 2412. Other transmission mechanisms can also be used.

  For the force feedback section, in an exemplary embodiment of the invention, the worm gear 2406 has a sufficiently small lead angle to prevent the pinion from reversing. Instead, a force that cancels the force applied by motor 2414 (eg, from the handle) moves worm gear 2406 in the axial direction of shaft 2407. Optionally, one or both of a viscous brake mechanism and an elastic resistance mechanism are provided to counteract this force. Various combinations of settings are provided, for example, the result is shown in FIG. 3B.

  As a result of the axial movement of the worm gear 2406, one of the two levers 2422 is displaced (the figure shows the mirror mechanism). The viscous cushion is optionally provided by a cushion 2440 that resists movement of the lever 2422. The cushion 2440 can be optionally adjusted, for example, manually or by a rehabilitation device. A linear electrometer or other position sensor is optionally used to detect the offset of the worm gear 2406.

  In the exemplary embodiment of the invention, spring 2420 resists movement of lever 2422. Optionally, motor 2424 can selectively preload spring 2420. In the illustrated embodiment, a pair of pulleys 2426 and 2430 and a belt 2428 cause the threaded shaft 2432 to rotate. In the exemplary embodiment of the invention, nut 2434 (or other mechanism) is threaded and converts the rotation of the screw into a preload of spring 2420. Optionally, shaft 2432 is threaded in opposite directions at both ends thereof. For example, it should be appreciated that a separate preload can be applied to each of the two springs 2420 when asymmetrical resistance is required, or to balance and balance gravity. Optionally, manual adjustment of the preload is provided by nut 2438 (perhaps also used for initial adjustments and settings).

  Optionally, pin 2436 limits the range of axial movement of worm gear 2406. It should be noted that if the preload is greater than zero, no axial movement of the worm gear 2406 occurs until this force is overcome. This corresponds to Fmin in FIG. 3B. Optionally, the force mechanism is set so that there is greater resistance to stretching (away from the body) movement than toward the body.

  In addition, other mechanical structures are also provided, such as the placement of springs 2420 on shaft 2407. In another example, the motor 2424 and the preload setting mechanism coupled thereto can be replaced with a single spring coupling the two levers 2422.

  This structure can provide various operating modes, for example.

  a) User passive mode. In this mode, the motor 2414 drives the worm gear 2406, and the worm gear 2406 rotates the pinion gear 2404 connected to the handle.

  b) Free user mode. In this mode, the user moves the handle in any direction determined by the user, and the system follows the user. In this embodiment, mechanism 2400 is used as a mechanical diode to decouple the user's movement from the motor. When the user exerts a force on the robot arm, the worm gear 2406 moves in the axial direction as described above. This linear motion can be measured and used as an input to the controller. The total amount of force felt by the user is largely determined by the preload of the spring 2420. The preload can be set or can be controlled by an electric preload motor as in this case.

  In the free user mode, the controller receives input from the linear electrometer and instructs the motor 2424 to move in the same direction. Thereby, a predetermined force is directed to the user so as to oppose the movement desired by the user.

  c) Restricted mode (force field). An additional use of the spring-motor co-operation is that the opposing force is minimal, but any deviation from the trajectory results in greater spring displacement, and thus (eg, as shown in FIG. 3A). ) Create a trajectory that induces a force to counter the deviation. Optionally, this mode is activated for a specific speed, resulting in isokinetic movement.

  d) Lead mode. The user starts to move in a certain direction, which is detected as the displacement of the worm gear 2406. This exercise can then be performed to the end by a rehabilitation device. Optionally, the exercise is completed only if the initiated movement is in a predetermined direction.

  e) Auxiliary mode. A preload is applied to the spring 2420 to push the handle in the direction of motion (eg, positive feedback) as the motion progresses. This may be a continuous force or it may be provided in pulses.

  f) Static. Optionally, the force mechanism is used to require the patient to apply a force to a point in space without substantially moving the handle. The force can be measured and / or controlled immediately. It should be noted that the spring mechanism can generally provide a force-responsive motion that is more realistic and smaller than direct robot motion using a friction mechanism or motor.

  A potential advantage of spring-motor co-operation is that it can provide speed and range limitations for movement. Another potential advantage is that a gradual (eg, resilient) stop can be provided even in an emergency stop. Another potential advantage is that viscous damping can provide a dynamic sensation.

  FIG. 24B is a flowchart 2460 of the operation of the device in freehand mode according to an exemplary embodiment of the present invention when two mechanisms 2400 are attached to the device of FIG. 22B. A similar process can be used to implement triaxial force control.

  Flowchart 2460 illustrates how the magnitude and direction of the force applied by the user is measured and used to guide handle movement. Processes 2462 to 2476 are described only for φ, but are executed for all axes (eg, θ).

  At 2462, a measured value of the φ offset amount is obtained.

  At 2464, optional filtering (eg, a low pass filter that smooths the signal and / or removes noise) is applied.

  At 2466, an adjustment operation (eg, matching to calibration values and controlling parameters) is optionally performed.

  At 2468, a noise gate is optionally used to convert a signal below the threshold to zero.

  At 2470, the magnitude and / or direction of the position change is optionally extracted.

  At 2472, a position command is optionally generated using a gain factor.

  At 2474, the position command is optionally fixed to be at least a minimum value (eg, to overcome friction and / or noise levels).

  At 2476, an absolute position command is optionally generated.

  At 2478, the speeds of the φ and θ axes are calculated. Optionally, further acceleration is calculated.

  At 2480, the modified composite vector is calculated. Optionally, the composite vector is the maximum value of φ and θ, rather than vector combinations, which may help stabilize the system and / or prevent mechanical problems.

  At 2482, a gain less than 1 is optionally applied, possibly increasing stability.

  At 2484, the velocity vector angle is optionally calculated.

  At 2486, the velocity components of φ and θ are calculated.

  At 2488, a command for a power source (eg, a motor) is generated.

[Bonding force control mechanism]
FIG. 25 shows an alternative force control mechanism 2500 that uses a single spring mechanism to couple the φ and θ axes. The handle 2502 is moved using an axis not shown. In one example, mechanism 2500 includes the internal mechanism of this embodiment described in FIG. 23 (external φ and θ axes are shown).

  Axes 2504 (and corresponding orthogonal axes not shown) include internal φ and θ axes about which handle 2502 rotates slightly when force control is activated. The bottom 2506 contacts the plate 2508. With this small amount of rotation, the plate 2508 is pushed down into a portion 2506 (although other shapes can be provided, the portion 2506 optionally has a round perimeter). This depression is subject to resistance by one or more springs (eg, four springs) 2510. The spring preload is set using a motor 2522. The motor 2522 can rotate the screw 2514 using a drive system consisting of pulleys 2520 and 2516 and a belt 2518, thereby lifting the base 2512 and compressing the spring 2510. Alternatively or additionally, manual preloading is performed.

  Optionally, a bushing 2524 or other known means is used to ensure linear movement of the plate 2508. A mechanical stop is provided for the relative movement of cap 2508 and base 2512 to prevent any movement with sufficient preload of spring 2510.

  The rounding of the end of portion 2506 may be calculated to ensure a linear relationship between rotation angle and displacement.

  The axis of internal rotation may coincide with the axis of external rotation, but this is not necessary. For example, the axes may not be coplanar and / or the axes may not be parallel.

  Various measuring means are provided, for example, a linear electrometer that measures spring displacement and / or a rotational electrometer that measures φ and θ rotations. The measured value may be used in the flowchart of FIG. 24B.

  Optionally, spring 2510 is used to provide flexibility in the z direction. In one example, spring 2510 provides a resistance when handle 2502 is depressed. The hinge of the shaft 2504 is optionally placed in the slot so that the hinge can move in the z-axis direction.

[Z-axis motion mechanism]
FIGS. 26A and 26B illustrate a z-axis motion and force response mechanism 2600, according to an illustrative embodiment of the invention. The mechanism comprises a telescoping rod consisting of three parts: a center 2604, a tip 2608, and a bottom 2606. An external motor (eg, 2304 in FIG. 23) is coupled to the coupling 2602 and thus rotates the rod 2609. The use of an external motor is optionally useful for modularity that allows the Z-axis mechanism to be manufactured at a lower cost and interchangeable with other Z-axis mechanisms. A coupling 2610 (eg, a nut) converts rotational motion into axial motion of the central portion 2604. The extension of portions 2604, 2606, and 2608 is optionally guided by a set of linear bearings, 2614 for portion 2608, and 2612 for portion 2606. Linear motion bearings are in grooves 2613 and 2611, respectively.

  In an exemplary embodiment of the invention, a coupled rack, pinion, and timing belt mechanism is used to synchronize the extension of portions 2606 and 2608 as follows. Each of the grooves 2611 and 2613 includes a rack (defined by the groove), and the portion 2604 includes two pinions 2616 and 2618, one at each end. As portion 2604 extends, rack 2611 rotates pinion 2616. A timing belt 2620 that couples pinions 2616 and 2618 (on the same effective diameter belt pulley coupled coaxially) causes a rotation synchronized with the pinion 2618. Pinion 2618 then moves rack 2613 to cause extension of portion 2608.

  In an exemplary embodiment of the invention, the telescoping mechanism allows the z-axis mechanism to be compact and useful for portability. It also allows movement near the center of rotation of the motion mechanism. In an exemplary embodiment of the invention, the telescoping mechanism allows extension ranges up to 2: 1 or near 3: 1 in the z-axis length. An additional telescope section is provided for a larger stretch ratio.

  For the top of the z-axis mechanism, a replaceable handle 2630 is shown. The axial movement of handle 2630 is optionally indicated by the movement of linear measurement electrometer 2638. Optionally, handle 2630 is attached using a quick connect mechanism.

  In an exemplary embodiment of the invention, spring 2632 provides a resilient resistance to the axial movement of handle 2630, for example using logic as described above in FIG.

  With reference to FIG. 26B, the spring 2632 is a spiral spring and its resistance can be changed by changing its effective length (eg, by moving a slide stop 2636 that determines the spring plate length of the spring 2632). This slide stop is optionally moved manually, for example, by rotating the housing 2634. Alternatively, an internal motor may be provided. This change in spring leaf length generally corresponds to a change in preload. The minimum force setting is provided by actually preloading the spring 2636 (eg, by the axial movement of that spring) or by applying it to another spring to resist axial movement. Will be done. Preloading may also be achieved by rotating the spring 2632 itself, thereby tensioning the spring.

  The range of motion of the force control mechanism can be, for example, a range of 3 cm, 5 cm, 10 cm, 15 cm, 20 cm, or intermediate, smaller, or larger.

  It should be noted that in some embodiments of the present invention, the use of a gear reduction ratio allows for the use of lower power and / or lower cost motors.

  It should be noted that z-axis forces can be transmitted using flexible or curved couplings. Thus, for example, the z-axis element can be a 90 degree L-shaped joint that extends only at a distant portion. Alternatively or additionally, a gooseneck-shaped mechanism is used to define the spatial shape for the z-axis element.

[game]
Various games are described. In exemplary embodiments of the present invention, one or more of the following game types are provided: role-playing games (adventure and D & D games), dynamic games (shooting games), board games and simulation games (e.g. Soccer and tennis).

  For example, a game is played one-on-one with a human opponent or a machine opponent.

  In an exemplary embodiment of the invention, device 100 serves as an input device that replaces, for example, a joystick. Alternatively or additionally, the device 100 is used as a VR input device, for example for reading limb positions. Alternatively or additionally, special input modes are defined. For example, the spatial position of the arm 102 can be mapped to a virtual position on the screen or in the game world, or to its velocity and / or acceleration. Gestures can be defined for various controls. For example, the “Launch”, “Rise” and “Land” commands can each have associated gestures.

  In an exemplary embodiment of the invention, a children's game is provided, for example, to encourage children with paralysis and CP (cerebral palsy) to avoid isolating their body parts. The device 100 can also be used as a social eye to prevent a paralyzed child from becoming a fallen person.

  In an exemplary embodiment of the invention, the game is played, for example, by limiting the required ROM, enhancing patient movement, changing the game speed, and changing the field of view that needs to be watched carefully. Adapted to patient ability.

  In an exemplary embodiment of the invention, the game is chosen to match the patient's motivation level. For example, a simple game is chosen for patients with low motivation.

[safety]
In an exemplary embodiment of the invention, one or more safety features are provided to prevent injury to the patient. For example, one or more of the following safety mechanisms are used.

a) Deadman's switch.
When the patient releases this switch (or touches the appropriate button), the movement of the device 100 is stopped and / or all forces and resistances are zeroed out. Other “evacuation port” configurations may be defined instead.

  b) Shear pin. A pin may be used to attach the tip 1008 (or other attachment) to the arm 1002. When the force exceeds a certain threshold, the pin tears and the attachment is released from the arm. Pins with various tear thresholds can be selected for various situations. Optionally, a wire can be attached to the pin for feedback. Optionally, the pin consists of two materials that are magnetically attracted (optionally with a degree of attraction set by the current).

  c) Lock. The arm 1002 may have an initial locking condition so that the patient can rest.

  d) Voice activation. Voice activation and / or deactivation may be provided to allow the patient to scream to stop the system.

  e) Analysis. Optionally, the actual movement and / or force applied by the patient is analyzed to assess whether the threshold is approaching or whether the patient is overstressed.

  f) Elasticity. A force control mechanism with a spring prevents a sudden stop from suddenly stopping the patient. Instead, the spring allows some suppleness and a more gentle stop.

  g) Measured force. When the force mechanism determines a force that exceeds a threshold and / or a spatial deviation, the motion can be stopped and optionally moved in the opposite direction of the force application.

[Balance training]
In an exemplary embodiment of the invention, a rehabilitation module is used for balance training. In one example, a seat is attached to the tip 1008 and the patient is seated on the seat. The non-rotating plate 1020 with slots sets the direction that allows the sheet to roll and the resistance level that determines the difficulty. Optionally, a handle bar is provided. Alternatively or additionally, a footrest and / or pedal is provided for the foot. Alternatively, one or more rehabilitation modules for the arm are provided. In this way, various daily and sports activities can be simulated and trained. Optionally, a virtual reality type display or television display is provided to enhance reality. Such a virtual reality display may be provided in other embodiments of the invention, for example, to display feedback, to display instructions, or to make an activity more interesting .

  US Provisional Patent Application No. 60 / 633,442, filed Dec. 7, 2004 (on the same filing date as this application, the same applicant filed a PCT application (titled “Method and Instrument for Rehabilitation Training and Training”, (Attorney Case Number 414/04388), the disclosure of which is incorporated herein by reference) describes balance training, for example using such a chair. Optionally, the complete body system is used to simultaneously train multiple body parts related to balance (eg, torso, arms, and / or legs).

  In an exemplary embodiment of the invention, the apparatus 100 is used to train balance while standing. For example, when the tip 108 is in various spatial positions (some positions only need to stretch the arm, some positions need to flex the torso), the patient can train to reach the arm 102. Do.

[Multimodal therapy and cooperative training]
In an exemplary embodiment of the invention, the device 100 can be used to provide rehabilitation in modes other than exercise. In one example, a (visual and / or visual) display is used to perform visual and / or auditory rehabilitation. Thus, a single device can be used for multiple rehabilitation modes (eg, at home) and serve as a single point of contact for the patient and the therapist. With multiple therapists, the device can be used to coordinate between various therapies and / or track general parameters such as general progress, motivation, and / or cognitive levels. In an exemplary embodiment of the invention, training with one of several modalities is selectively applied, for example for load balancing and / or interest.

  In an exemplary embodiment of the invention, apparatus 100 is used to rehabilitate cooperation between modalities and / or one modality rehabilitation is used to aid in rehabilitation of other modalities. One example is vision and hand coordination, where the patient is shown the target on the screen, moving the tip 108 and pinching it. Another example is timing, where the patient needs to give commands at a certain timing, possibly due to an auditory modality. Spatial planning in which the patient is given verbal instructions that increase gradually in complexity regarding spatial movement.

  In an exemplary embodiment of the invention, increasingly complex visual instructions, motor activity, and feedback (visual or not) are provided to the patient. Similarly, increasingly complex auditory, kinesthetic, tactile, and olfactory feedback (using scented attachments) and / or instructions are provided.

  In a specific example, language recognition is rehabilitated in coordination with exercise. It is required to understand the language fast enough to perform the exercise, for example in time or in response to verbal instructions. The user may be asked to provide a language statement consistent with his movement. A language recognition module can also be provided.

  In another example, visual stimuli become more complex over the course of visual rehabilitation. For example, starting with light, the next light in position, the next blinking speed, the next sentence to read, all of which serve as an exercise or feedback (eg as an increasingly complex exercise task Is: moving an arm, moving in a certain direction, moving to a specific area).

  A particular advantage of some embodiments of the device 100 is that mechanical feedback and assistance is provided to the patient. In some embodiments, some methods of motor rehabilitation described herein (and thus provide special utility) may include, for example, motivation assessment, remote rehabilitation, collective activity, and user activity. Used for non-motor rehabilitation, such as computer support (eg, for group participation).

[Other devices]
Various designs for robots and positioning devices (eg, hexapods, etc.) are known. It should be appreciated that the various descriptions described herein can be adapted to such robots and positioning devices in accordance with exemplary embodiments of the present invention. Alternatively or additionally, software may be provided for such robots and devices to perform all of the various methods described herein in accordance with all exemplary embodiments of the invention. .

  US Provisional Patent Application No. 60 / 604,615, filed Aug. 25, 2004, the disclosure of which is incorporated herein by reference, describes taking into account the effects of brain plasticity. The methods described herein can use EEG or fMRI as input, for example, to determine the type of feedback or device mode to use.

  US Provisional Patent Application No. 60 / 566,078 filed April 29, 2004 (also PCT application filed on the same day as the present application (titled “Neuromuscular Stimulation”, agent case no. 414 / 04400), the disclosures of both applications are incorporated herein by reference) to stimulate a paralyzed limb while exercising the limb or otherwise assisting limb movement Explain what to do. For example, healthy limb EMG measurements are optionally used as part of the present teachings to determine paralyzed limb stimulation and / or assisted movement.

  It should be noted that the rehabilitation devices described herein can optionally be used not only at home, but also in nursing homes, hospitals, and care centers such as rehabilitation centers.

  It will be appreciated that the above-described rehabilitation methods can be varied in many ways, including omission or addition of steps, change of the order of steps and the type of equipment used. Furthermore, the diversity of both the method and the apparatus has been described. In some embodiments, the method has mainly been described, but instruments adapted to the implementation of the method are also within the scope of the present invention. It should be appreciated that various features can be combined in various ways. In particular, not all of the features in the individual embodiments described above are necessarily required in all similar embodiments of the invention. Furthermore, combinations of the above features are also included within the scope of some embodiments of the invention. The scope of the invention also includes kits that include multiple sets of devices, one or more shear pins, one or more attachments, and / or software. Also included are hardware, software, and computer-readable media containing the software used to perform and / or guide the steps described herein, such as controlling arm position and providing feedback. And within the scope of the present invention. An item heading is provided to help navigation, and does not necessarily limit the content of the item. The terms “comprises” (“consisting of”, “comprising −”, “including −”), “includes” (“including −”), “have” (“having −” are used in the claims. ”,“ Having — ”), and their congenital terms mean“ including but not limited to ”). It should also be noted that the device is suitable for both men and women.

  It will be appreciated by those skilled in the art that the present invention is not limited by what has been described above. Rather, the scope of the present invention is limited only by the claims.

1 schematically illustrates an articulated arm rehabilitation device according to an exemplary embodiment of the present invention. 1 is a schematic block diagram of a remote rehabilitation system according to an exemplary embodiment of the present invention. FIG. 6 illustrates a force field generated by a rehabilitation device, according to an exemplary embodiment of the present invention. FIG. 6 is a diagram illustrating an exemplary profile of resistance force. 3 is a flowchart of a method for using a rehabilitation device, according to an illustrative embodiment of the invention. 3 is a flowchart of long-term use of a rehabilitation device, according to an exemplary embodiment of the present invention. 1 illustrates a system with limb position sensing capability according to an exemplary embodiment of the present invention. FIG. FIG. 6 shows an elbow retention attachment, according to an illustrative embodiment of the invention. FIG. 2 shows a two-handed rehabilitation device according to an exemplary embodiment of the present invention. FIGS. 9A and 9B illustrate an apparatus for controlled movement of multiple points in the body according to an exemplary embodiment of the present invention. 1 shows a ball rehabilitation device according to an exemplary embodiment of the present invention. FIG. FIG. 11 shows the balancing of the rehabilitation device of FIG. 10 according to an exemplary embodiment of the present invention. It is a figure explaining the drive system of a plate type rehabilitation device by an exemplary embodiment of the present invention. FIG. 2 illustrates a coupling device of a plate drive system according to an exemplary embodiment of the present invention. FIG. 5 illustrates a plate with flexible slots, according to an exemplary embodiment of the present invention. FIG. 2 illustrates a two-plate rehabilitation device according to an exemplary embodiment of the present invention. FIG. 6 illustrates a guide plate according to an exemplary embodiment of the present invention. FIG. 6 illustrates a restoration attachment that provides control and / or feedback to one or more hand movements according to an exemplary embodiment of the present invention. FIG. 6 shows various attachments according to an exemplary embodiment of the present invention. FIG. 6 illustrates various methods of elbow support according to an exemplary embodiment of the present invention. It is a figure explaining the rehabilitation apparatus which changed direction according to exemplary embodiment of this invention. FIG. 6 shows an alternative rehabilitation device with a changed orientation, according to an exemplary embodiment of the present invention. FIG. 6 shows an alternative rehabilitation device with a changed orientation, according to an exemplary embodiment of the present invention. FIG. 2 shows a rehabilitation device for arms and legs according to an exemplary embodiment of the present invention. FIG. 2 shows a rehabilitation device for both sides of the body, according to an exemplary embodiment of the present invention. FIG. 3 illustrates a docking station according to an exemplary embodiment of the present invention. FIG. 19B shows the docking station of FIG. 19B in use. FIG. 3 shows a mobile rehabilitation device placed near a bed according to an exemplary embodiment of the present invention. FIG. 6 illustrates an alternative mobile rehabilitation device coupled to a bed, according to an illustrative embodiment of the invention. FIG. 6 illustrates the use of a mobile rehabilitation device in a bathtub according to an exemplary embodiment of the present invention. FIG. 3 shows a rehabilitation device configured for daily activities according to an exemplary embodiment of the present invention. FIG. 2 shows an apparatus for assisting in training daily activities according to an exemplary embodiment of the present invention. FIG. 3 illustrates a chuck mechanism according to an exemplary embodiment of the present invention. FIG. 4 shows an alternative, non-ball, balanced, rehabilitation device according to an exemplary embodiment of the present invention. FIG. 6 illustrates another alternative non-ball rehabilitation device mechanism according to an exemplary embodiment of the present invention. It is a figure which shows the control mechanism and brake which are attached to the apparatus of FIG. 22A to force. FIG. 6 shows a cantilever rehabilitation device mechanism according to an exemplary embodiment of the present invention. FIG. 22C is a side cross-sectional view of the force control mechanism used in FIG. 22B, according to an illustrative embodiment of the invention. FIG. 24B is a flowchart of the operation of the mechanism of FIG. 24A, according to an illustrative embodiment of the invention. FIG. 6 shows a force control mechanism according to an alternative embodiment of the present invention. FIG. 3 illustrates a Z-axis extension mechanism, according to an exemplary embodiment of the present invention. FIG. 26B illustrates a force control mechanism for the attachment illustrated in part of FIG. 26A, according to an exemplary embodiment of the present invention.

Claims (24)

A method of controlling at least first and second rehabilitation devices that are used for training on the same patient and that are communicable with each other, wherein the first and second rehabilitation devices are first and second, respectively. with the actuator, the first and second actuators, respectively, at least a first and second program control device, in at least three degrees of freedom of movement of the actuator, in a volume part of the diameter of at least 30 cm, a predetermined A force can be applied to the tip to assist or guide the movement of the patient's limb along the trajectory of the patient, or to resist movement out of the predetermined trajectory within a predetermined range , and within the volume portion. a substantial movement of arbitrary direction at any point, the above predetermined range from the predetermined trajectory First and second motion mechanism which can prevent the movement out are those having, the method comprising
Controlling the first actuator by the first program controller for a first training at a first rehabilitation location selected from a bed, a wheelchair, a clinic, and a home;
Based on communication with the first rehabilitation device, the second actuator for second training at a second rehabilitation location selected from a bed, a wheelchair, a clinic, and a home, Controlling by the second program control device in synchronization with a first actuator,
The first movement mechanism and the second movement mechanism have the same structure,
The first training and the second training each use at least one of a plurality of modularly replaceable attachments at the tip.   The method of claim 1, wherein the first and second motion mechanisms are motorized.   The method of claim 2, wherein the first and second motion mechanisms can apply a force of at least 1 kgf to the tips of the first and second actuators, respectively.   The method according to claim 2 or 3, wherein the first and second movement mechanisms can apply different magnitudes of force in different directions of movement of the first and second actuators, respectively.   5. A method according to any preceding claim, wherein the first and second motion mechanisms are configured to optionally add variable resistance to the motion of the first and second actuators.   The first and second actuators are configured to be controlled in a plurality of modes including at least a user passive mode for causing the motion, an auxiliary mode for inducing the motion, and a free user mode for recording the motion. 6. The method according to any one of claims 1 to 5, wherein:   The method of claim 6, wherein the first and second training use different modes.   The method according to claim 1, wherein at least one of the first and second exercises is performed in water.   The method according to claim 1, wherein the first and second exercises are performed on the same limb.   The method according to claim 1, wherein the first and second exercises are different exercises.   11. A method according to any one of the preceding claims, comprising tracking the patient's progress including the first and second exercises in a control device coupled to the second actuator.   The method according to claim 1, wherein the first and second actuators are made of hard members. A first rehabilitation device using a first actuator and a first operational setting used at a first rehabilitation location;
A second rehabilitation device that communicates with the first rehabilitation device using a second actuator and a second operational setting used at a second rehabilitation location;
A rehabilitation system configuration comprising:
The first rehabilitation device and the second rehabilitation device are used for training for the same patient, and the first rehabilitation training provided by the first actuator is the second rehabilitation device. The first and second actuators are both synchronized with each other in a volume portion of at least 30 cm in diameter, and at least three degrees of freedom of movement of the actuator along a predetermined trajectory. A force that assists or induces movement of the limbs or resists movement that deviates within a predetermined range from the predetermined trajectory can be applied to the tip, and at any point in the volume portion a substantial movement direction, inhibitory motion that deviates more than the predetermined range from the predetermined trajectory Have the potential movement mechanism,
The first and second rehabilitation apparatuses each have a rehabilitation system configuration in which at least one of a plurality of modularly replaceable attachments is used at the distal ends of the first and second actuators.   14. The system configuration of claim 13, wherein the first and second rehabilitation locations are selected from a bed, a wheelchair, a clinic, a hospital, and a home.   The first operational setting includes applying a force that assists or induces or resists movement of the patient's limb with at least three degrees of freedom; and the second operational setting includes at least 15. A system configuration according to claim 13 or claim 14, comprising applying a force that assists or induces or resists movement of a patient's limb in two degrees of freedom.   The system configuration according to claim 13, wherein the first operation setting includes having modular software, and the second operation setting includes having different modular software.   The system configuration according to any one of claims 13 to 16, wherein the first operation setting includes various operation modes, and the second operation setting includes only a part of the operation mode.   The system configuration according to any one of claims 13 to 17, wherein the first rehabilitation device includes a first display, and the second rehabilitation device includes a different display.   The system configuration according to claim 18, wherein the second rehabilitation device is movable.   20. The system configuration according to claim 18 or 19, wherein the second rehabilitation device can be of a different size compared to the first rehabilitation device.   The system configuration according to any one of claims 13 to 20, wherein the first and second rehabilitation devices are connected via a network.   The system configuration of claim 21, wherein the network comprises a database shared between at least the first and second rehabilitation devices.   23. A system configuration according to claim 21 or claim 22, wherein the system is adapted to generate reports about the patient from the first and second rehabilitation devices.   The system configuration according to any one of claims 13 to 23, wherein the first rehabilitation device and the second rehabilitation device are monitored by the same therapist.

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